联合肝脏分隔和门静脉结扎的二步肝切除术的回顾与展望

Retrospect and prospect of associating liver partition and portal vein ligation for staged hepatectomy

  • 摘要: 联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)是针对剩余肝脏体积(FLR)非常少量而要求行扩大肝切除术的晚期肝脏恶性肿瘤采用的改良二步肝切除术。该手术方式的特点为通过使剩余肝脏急速增生而安全地施行扩大肝切除术,从而扩大肝癌根治性切除术的适应证。然而,ALPPS的并发症发生率及病死率远高于门静脉栓塞术后的扩大肝切除术。日本外科医师一直追求肝切除术后的零死亡率,因此,ALPPS的发展备受争议。本研究回顾ALPPS的发展,总结ALPPS存在的问题,从而反思ALPPS在日本的应用现状。

     

    Abstract: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is introduced as a modified two staged hepatectomy for advanced liver malignancies, which requires extended hepatectomy with very small future remnant liver volume. It is characterized by rapid and large growth of future remnant liver and potential of widening the indication of curative resection with extended major hepatectomy for liver malignancies. However, it showed much higher morbidity of complications and mortality than extended hepatectomy after portal vein embolization. The development of ALPPS is often controversial. In this article, the development and pro blems of ALPPS are retrospected and summarized, in order to reflect the role of ALPPS in Japan where zero mortality after hepatectomy is highly expected.

     

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