摘要目的:分析射频消融辅助的联合肝脏离断和门静脉结扎的二步肝切除术(RALPPS)在剩余肝体积(FLR)不足肝癌患者中的应用效果。方法:回顾分析2014年6月至2020年7月在陆军军医大学第一附属医院行RALPPS的29例肝癌患者资料，其中男性25例，女性4例，年龄(46.6±9.9)岁。按是否成功行二期手术分为二期组(完成二期手术， n＝18)和一期组(仅完成一期手术， n＝11)。比较两组FLR、FLR占标准肝体积百分比(即FLR百分比)、FLR增长率、术后肝功能、一期手术时间、射频消融时间、手术并发症等。 结果:29例患者一期术前FLR百分比为(30.0±7.0)%，18例(62.1%)患者完成二期手术。一期手术后二期组天冬氨酸氨基转移酶为519.0(362.9，696.0)U/L、丙氨酸氨基转移酶391.8(297.2，591.1)U/L，优于一期组931.0(711.7，1 131.9)U/L、851.3(426.6，888.0)U/L，差异有统计学意义(均 P<0.05)。两组一期术前FLR、一期术前FLR百分比、一期手术时间、一期手术出血量、射频消融时间等方面比较，差异均无统计学意义(均 P>0.05)。二期组两次手术间隔(21.6±6.7)d，二期术前FLR(623.2±101.8)cm 3、FLR百分比(49.0±7.0)%，FLR增长率(19.0±5.0)%。一期组术后发生并发症11例(100.0%)，Clavien-Dindo Ⅲb级及以上7例(63.6%)。二期组一期手术后发生并发症18例(100.0%)，无Ⅲb级及以上并发症。11例未行二期手术的原因有一期术后肝功能差和FLR不足4例、肿瘤进展6例、死亡1例。 结论:RALPPS是FLR不足肝癌患者的一种治疗选择，治疗效果尚可。

abstractsObjective:To analyze the apply effect of radiofrequency ablation assisted associating liver partition and portal vein ligation for staged hepatectomy (RALPPS) in liver cancer patients with insufficient future liver remnant (FLR).Methods:The data of 29 patients who underwent RALPPS in the First Affiliated Hospital of the Army Military Medical University from June 2014 to July 2020 were analyzed, including 25 males and 4 females, aged (46.6±9.9) years. The patients were divided into the second stage group (completed the second stage operation, n=18) and the first stage group (completed only the first stage operation, n=11) according to whether they had successfully completed the second stage operation. FLR, percentage of FLR in standard liver volume (percentage of FLR), growth rate of FLR, liver function after operation, operation time and radiofrequency ablation time of first stage operation, surgical complications were compared between the two groups. Results:The percentage of FLR before the first stage operation was (30.0±7.0)% in 29 patients, and the second stage operation was completed in 18 patients (62.1%). After the first stage operation, the aspartate aminotransferase and alanine aminotransferase in the second stage group were 519.0 (362.9, 696.0) U/L and 391.8 (297.2, 591.1) U/L, which were better than those of the first stage group 931.0 (711.7, 1131.9) U/L and 851.3 (426.6, 888.0) U/L (both P<0.05). There was no significant difference between the two groups in FLR and percentage of FLR before the first stage operation, duration time, amount of bleeding and time of radiofrequency ablation of the first stage operation (all P>0.05). In the second stage group, the interval between two operations was (21.6±6.7) days, the FLR before the second stage operation was (623.2±101.8) cm 3, the FLR percentage was (49.0±7.0)%, and the FLR growth rate was (19.0±5.0)%. In the first stage group, there were 11 patients (100.0%) who developed complication after first stage operation, induding 7 patients (63.6%) with complication above Clavien-Dindo grade Ⅲb. In the second stage group, 18 patients (100.0%) developed complication after the first stage operation. There were no complication above grade Ⅲb. The causes of 11 patients who did not completed secondary surgery included poor liver function and insufficient FLR in 4 patients, tumor progression in 6 patients, and death in 1 patient. Conclusion:RALPPS is a therapeutic option for liver cancer patients with insufficient FLR, and the therapeutic effect is reasonable.