对“联合肝脏离断和门静脉结扎的二步肝切除术”的述评
Comments on 〖WTHX〗Associating liver partition and portal vein ligation for staged hepatectomy
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摘要: 联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)是一个非常新的外科手术。该手术主要针对因未来剩余肝脏体积较小而不能接受大范围肝切除术的T分期较晚的肝癌患者而设计的。ALPPS第1步手术后，患者剩余肝脏对手术的反应非常强烈，使得肝脏体积急剧增生。因而可在第1步手术后1周左右施行第2步手术以切除所有肝内肿瘤(R0切除)。本文追溯ALPPS的发展历史，描述该手术的传统步骤和手术的偏离等情况,分析该手术的短期疗效。尽管ALPPS后零死亡已有报道，但初步的研究结果表明：ALPPS的手术死亡率和并发症发生率仍然较高。ALPPS后尚没有明确的长远治疗肿瘤效果的报道。该手术在肝硬化肝癌患者中能否安全施行尚有疑问。Abstract: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a recently developed 2 stage operation designed for patients with an advanced T stage hepatobiliary malignancy in the liver who cannot tolerate extensive liver resection because of the low future liver remnant volume. The dramatic liver regenerative response after the first staged operation results in dramatic and rapid hypertrophy in the future liver remnant. As a consequence, the second staged operation aiming to remove all tumors (R0 resection) can be carried out, usually, in about a week's time. This article traces the history of development of ALPPS, analyses its short term results, describes how the classical ALPPS is carried out, and lists out its modifications, techniques and variations.There are obvious advantages and disadvantages of ALPPS, which has its indications and contraindications.Initial results show ALPPS to have relatively high operative mortality and morbidity rates, although 0 mortality has been reported. The long term oncological result of ALPPS is unknown. There is also lack of data on ALPPS carried out on cirrhotic patients.
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