本文選題：癌　切入點(diǎn)：肝細(xì)胞　出處：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:聯(lián)合肝臟離斷和門靜脈結(jié)扎的二步肝切除術(shù)(Associating liver partition and portal vein ligation,ALPPS)旨在預(yù)防肝大部切除術(shù)后殘肝體積不足而導(dǎo)致的急性肝功能衰竭。通過對(duì)肝細(xì)胞肝癌合并肝硬化病例實(shí)施ALPPS手術(shù)的臨床資料回顧性分析,探討這一手術(shù)方式在巨塊型肝癌合并肝硬化病例中的可行性和安全性。方法:回顧分析2014年9月至2016年10月,北京協(xié)和醫(yī)院肝臟外科收治的共9例巨塊型肝癌合并肝硬化行ALPPS手術(shù)病例。分析第二步手術(shù)完成率、殘肝體積(future liver remnant,FLR)增長率、死亡率。系統(tǒng)檢索ALPPS對(duì)比傳統(tǒng)二步肝切除術(shù)的相關(guān)文獻(xiàn),從符合標(biāo)準(zhǔn)的文獻(xiàn)中提取第二步手術(shù)完成率、手術(shù)并發(fā)癥、死亡率、FLR增長率等指標(biāo),進(jìn)行Meta分析。結(jié)果:全部9例病例均完成兩步手術(shù)且未發(fā)生嚴(yán)重并發(fā)癥;無術(shù)后死亡病例。通過Meta分析發(fā)現(xiàn)ALPPS病例術(shù)后FLR增長明顯高于門靜脈栓塞和門靜脈結(jié)扎的二步肝切除術(shù)病例,兩者比較有統(tǒng)計(jì)學(xué)差異(42.2%;95%CI 26.52-57.87,P0.001;47.65%;95%CI 29.43-65.88%,P0.001);手術(shù)并發(fā)癥發(fā)生率及術(shù)后死亡率與門靜脈栓塞和門靜脈結(jié)扎的二步肝切除術(shù)病例比較無統(tǒng)計(jì)學(xué)差異(27.7%;OR 0.723,95%CI 0.258-2.207,P = 0.537;44.7%;OR 0.553,95%CI 0.158-1.938,P = 0.371),(35.6%;OR 0.644,95%CI 0.166-2.499,P = 0.524;42.9%;OR 0.571,95%CI 0.07-4.683,P = 0.602)。結(jié)論:ALPPS技術(shù)對(duì)于殘肝體積不足的巨塊型肝癌合并肝硬化的病例安全、可行,為這類患者增加了手術(shù)治療的機(jī)會(huì)。對(duì)比傳統(tǒng)二步肝切除術(shù),ALPPS能獲得更快殘肝體積增長,第二步手術(shù)完成率更高,且未增加手術(shù)并發(fā)癥發(fā)生率及術(shù)后死亡率。
[Abstract]:Objective: to prevent acute hepatic failure caused by hepatic remnant insufficiency after partial hepatectomy with portal vein ligation combined with two-step hepatectomy with associated liver partition and portal vein ligation (ALPPSs). Clinical data of patients undergoing ALPPS operation were retrospectively analyzed. Objective: to investigate the feasibility and safety of this procedure in patients with massive liver cancer complicated with cirrhosis. Methods: from September 2014 to October 2016, a retrospective analysis was made. A total of 9 patients with giant liver cancer complicated with cirrhosis underwent ALPPS operation in the Department of liver surgery, Peking Union Hospital. The rate of completion of the second step operation and the growth rate of residual liver volume in future liver liver were analyzed. The mortality rate, operative complications, mortality rate, mortality rate and mortality rate of ALPPS were extracted from the standard documents. The mortality rate of ALPPS was higher than that of traditional two-step hepatectomy. The mortality rate of ALPPS was compared with that of traditional two-step hepatectomy. Meta analysis was performed. Results: all 9 cases underwent two-step operation without serious complications. Meta analysis showed that the increase of FLR in ALPPS patients was significantly higher than that in two-step hepatectomy patients with portal vein embolism and portal vein ligation. There was no significant difference in the incidence of postoperative complications and mortality with portal vein embolism and portal vein ligation in two-step hepatectomy cases. There was no statistical difference in 27.7OR 0.72395CI 0.258-2.207P = 0.53737 / 44.7CI 0.55395CI 0.158-1.9338 P = 0.37195 / 0.64495CI 0.166-2.4999P = 0.5242.995 / 0.571.95 / 95 / 0.55395CI 0.158-1.938 P = 0.371/ 0.64495CI 0.166-2.4999P = 0.5242.995 / 0.57.1. Conclusion\\\% ALPPS technique is safe for patients with massive hepatocellular carcinoma with insufficient residual liver volume and liver cirrhosis, P = 0. 07-4. 683 (P = 0. 602). Compared with traditional two-step hepatectomy, ALPPS can obtain faster residual liver volume growth, higher completion rate of the second step operation, and no increase in the incidence of complications and postoperative mortality.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7;R657.31

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