目的：探讨腹腔镜一期开腹二期ALPPS（联合肝脏离断和门静脉结扎二步肝切除术）治疗巨块期肝癌的可行性及有效性。方法：回顾性分析2014年4月—2016年4月12例巨块型肝癌（直径>10 cm）合并肝硬化患者行腹腔镜一期开腹二期ALPPS的临床资料。结果：治疗前，患者肝功能均为Child B级、平均ICGR15为（23.4±1.5）%、计算剩余肝体积（FLR）为（308±64）mL，占全肝体积比为（27±3.8）%。一期手术中，除1例中转开腹外其他均成功实施全腹腔镜手术；一期手术后，所有患者的肝功能均转为Child A级，ICGR15为（8.6±4.2）%、FLR体积为（684±129）mL，占全肝体积比为（56±7.7）%。两次手术的平均间隔时间为10.5（7~16）d。二期开腹手术中，7例为扩大右半肝切除术，5例为右三肝切除术，术中平均失血量650（200~1 200）mL，术中平均输血量为3.5（1.5~6）U。术后无严重并发症，腹水与一过性胆汁漏经保守治疗后痊愈，无围手术期死亡。术后随访6~30个月，3例死亡，其余生存。结论：腹腔镜一期开腹二期ALPPS是巨块型肝癌安全、有效的方法。
Efficacy of laparoscopic first stage and open second stage ALPPS for huge hepatocellular carcinoma
Objective: To investigate the feasibility and efficacy of laparoscopic first stage and open second stage ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) in treatment of huge hepatocellular carcinoma (HCC). Methods: The clinical data of 12 patients with huge HCC with concomitant liver cirrhosis undergoing laparoscopic first stage and open second stage ALPPS from April 2014 to April 2016 were retrospectively analyzed. Results: Before treatment, all patients were classified as Child B liver function, the average ICGR15 was (23.4±1.5)%, and the estimated future liver remnant (FLR) was (308±64) mL with a ratio of (27±3.8)% to the total estimated liver volume. In the first-stage operation, except one case of open conversion, laparoscopic procedure was successfully performed in all remaining cases; after the first-stage operation, the liver function transferred to Child A in all patients, the average ICGR15 was (8.6±4.2)%, and FLR was (684±129) mL with a ratio of (56±7.7)% to the total estimated liver volume. The average time interval between the first- and second-stage operations was 10.5 (7–16) d. in the open second-stage operation, 7 patients underwent extended right hemihepatectomy and 5 patients underwent right hepatic trisegmentectomy, with an average intraoperative blood loss of 650 (200–1 200) mL and blood transfusion of 3.5 (1.5–6) U respectively. No severe postoperative complications occurred, and the ascites and transient bile leakage were resolved by conservative treatments. Postoperative follow-up was conducted for 6 to 30 months, during which time, 3 patients died and the remaining patients were alive. Conclusion: Laparoscopic first stage and open second stage ALPPS is a safe and effective treatment method for huge HCC.