Clinical Analysis Of ALPPS And Conventional Radical Resection Combined With Segmental Hepatectomy In The Treatment Of Hilar Cholangiocarcinoma

Objective:Associating liver partition and portal vein ligation(ALPPS)is a new radical treatment for advanced liver tumors.Based on the retrospective analysis of the clinical data of ALPPS operation and conventional radical resection combined with segmental resection in patients with hilar cholangiocarcinoma,the safety and therapeutic effect of ALPPS operation on patients with hilar cholangiocarcinoma were discussed in this paper.Methods:Retrospective analysis of clinical data of patients with hilar cholangiocarcinoma confirmed by pathology from June 2015 to June 2018 in the Department of Hepatobiliary surgery,people's Hospital of Zhengzhou University.According to the different operative methods,they were divided into Conventional radical resection group(n=33)and ALPPS group(n=8),the general clinical data,changes in clinical biochemical indexes,perioperative complication rate and mortality,and postoperative survival period of the patients were statistically analyzed to evaluate the difference in efficacy between the two surgical methods and patients with hilar cholangiocarcinoma.Results:All the 8 patients in ALPPS group successfully completed the surgery.Among them,4 cases received left hemihepatectomy combined with caudate lobectomy,3 cases received right hemihepatectomy combined with caudate lobectomy,and 3 cases received left trilobectomy combined with caudate lobectomy.There were no perioperative deaths,and all the patients were recovered.There were no serious complications above Clavien-Dindo grade ?b,including 6 cases of pulmonary infection,2 cases of primary postoperative bile leakage,1 case of grade A bile leakage and 1 case of secondary abdominal infection of grade B bile leakage,and 1 case of gastrointestinal bleeding.1 case developed biliary tract infection secondary to hepatic artery thrombosis after secondary operation.In the Conventional operation group,all 33 patients completed the operation,including 15 cases of left hemihepatectomy combined with caudate lobectomy,11 cases of right hemihepatectomy combined with caudate lobectomy,and 5 cases of left trilobectomy combined with caudate lobectomy.2 cases underwent right trilobectomy combined with caudate lobectomy.The incidence of postoperative complications was 27.3%,and no perioperative death,including bile leakage in 4 cases(grade A in 3 cases,grade B in 1 case).After symptomatic conservative treatment,abdominal infection in 3 cases,pulmonary infection in 1 case and incision infection in 2 cases were cured.The infection was controlled after conservative treatment,There were no serious complications of Clavien-Dindo ?b or above.In ALPPS group,8 patients were followed up for 9 ~ 35 months,1 case of hepatic artery thrombosis died of sepsis secondary to hepatic abscess 10 months later,2 cases of tumor recurred,and 1 case of hepatic artery thrombosis died of hepatic abscess secondary sepsis 10 months later.One case of recurrent biliary obstruction died of liver failure 22 months after PTCD,and the other 4 cases were followed up for 9,16,19 and 35 months,respectively,and no tumor recurrence was found.In the routine operation group,33 patients were followed up for 8 ±41 months,with a median follow-up time of 25 months.Among them,3 cases were followed up for ? 36 months,2 cases died of tumor recurrence,1 case survived without tumor,15 cases were followed up for ? 24 months and < 36 months,8 cases died at present,and 2 cases underwent PTCD operation after obstructive jaundice.9 cases were followed up for more than 12 months and less than 24 months,2 cases died and the rest survived,6 cases died within 12 months,1 case died,died of malignant arrhythmia 8 months after operation,and the rest survived.Conclusion:1?In patients with hilar cholangiocarcinoma who could not achieve R0 resection,although the rate of postoperative complications was high,However,the two-step hepatectomy associating liver partition and portal vein ligation can achieve the same curative effect and survival time as conventional radical hepatectomy.2?Compared with conventional radical operation,the incidence of perioperative complications of ALPPS is higher,and its safety is lower than that of conventional radical operation.It is necessary to choose this operation carefully.