Liu Baihui,Xie Lulu,Yao Wei,et al.Application of associating liver partition and portal vein ligation during two-stage hepatectomy for massive hepatoblastoma[J].Journal of Clinical Pediatric Surgery,2023,22(12):1119-1123.[doi:10.3760/cma.j.cn101785-202309028-005]
联合肝脏离断和门静脉结扎二步肝切除术治疗儿童巨大肝母细胞瘤
- Title:
- Application of associating liver partition and portal vein ligation during two-stage hepatectomy for massive hepatoblastoma
- Keywords:
- Hepatoblastoma; Portal Vein; Surgery; Hepatectomy; Treatment Outcome; Child
- 摘要:
- 目的 探讨联合肝脏离断和门静脉结扎的二步肝切除术(application of associating liver partition and portal vein ligation,ALPPS)治疗儿童巨大肝母细胞瘤(hepatoblastoma,HB)的可行性及有效性。方法 回顾性收集2016年7月至2020年2月在复旦大学附属儿科医院肿瘤外科行ALPPS手术治疗的4例HB患儿临床资料,总结分析患儿临床特征、手术方式、治疗结果以及术后随访结果。结果 4例均成功实施ALPPS手术。其中男1例,行肝左叶及Ⅶ、Ⅷ肝段切除术;女3例,行右半肝扩大切除术。术前肿瘤分期:1例为PRETEXT Ⅳ期,3例为PRETEXT Ⅲ期,均经肿瘤活检确诊为HB。1例术前未行化疗,3例术前予4~7次新辅助化疗。术前肝功能均无异常,CT及三维重建技术评估肿瘤最大直径8~15.7 cm,剩余正常肝脏体积(future liver remnant,FLR)占全肝体积(total liver volume,TLV)比在一期手术前为12%~35.1%,二期手术前为16.3%~85.2%。两次手术间隔时间为6~9 d(平均7 d)。一期手术时间平均286 min,平均出血量150 mL,无一例严重围手术期并发症。二期手术平均时间127 min,平均出血量112 mL,围手术期出现胆道梗阻1例。术后随访26个月,2例无瘤生存;1例术后辅助化疗期间出现双肺转移瘤,1例出现右下肢肿瘤,活检提示为尤文氏肉瘤,现2例均带瘤生存。结论 ALPPS手术用于治疗FLR不足的儿童巨大HB是可行且有效的。术前需严格把握手术适应证。然而手术对于FLR的要求以及儿童肝切除后肝衰竭的定义尚需扩大样本量进一步研究和评估。
- Abstract:
- Objective To explore the efficacy and safety of associating liver partition and portal vein ligation during two-stage hepatectomy (ALPPS) for massive hepatoblastoma.Methods The relevant clinical data were reviewed retrospectively for 4 children with hepatoblastoma undergoing ALPPS between July 2016 and February 2020.Results There were 1 boy and 3 girls with an average age of 39.5 months).ALPPS was successful.Mean future liver remnant of total liver volume (FLR/TLV) pre-intervention was (12-35.1)% and (16.3-85.2)% before stage Ⅱ resection.The average operation duration and blood loss for stages Ⅰ and Ⅱ were 286 min,150 mL and 127 min,112 mL respectively.No postoperative mortality occurred.One child underwent laparotomy and hepatic duct jejunum Roux-Y anastomosis due to obstructive jaundice after stage Ⅱ resection.During a postoperative follow-up period of (4-14) months,there were tumor-free survival (n=2),lung metastasis during chemotherapy after ALPPS (n=1) and right bone Ewing’s sarcoma (n=1).Conclusions ALPPS is both efficacious and safe for children with massive hepatoblastoma having insufficient residual liver volume for complete resection.However,more confirmative data should be required and clinical indications of ALPPS further verified in future studies.
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备注/Memo
收稿日期:2023-9-16。
基金项目:上海市临床重点专科(shslczdzk05703);唐仲英基金会(ZSBK0070);上海市抗癌协会"雏鹰"计划(SACA—CY22C14)
通讯作者:董岿然,Email:kuirand@hotmail.com