联合肝脏离断和门静脉结扎二步肝切除术几个焦点问题

Some hot topics on associating liver partition and portal vein ligation for staged hepatectomy

联合肝脏离断和门静脉结扎二步肝切除术(ALPPS)作为姑息治疗手段之一,让未来剩余肝脏体积不足的较晚期巨大肝癌病人重获手术切除的机会。但目前该术式仍存在风险和难点,并且其所带来的长期存活获益尚无定论,故其发展一直伴随着争议。在充分评估未来剩余肝脏扩增能力的前提下,个体化选择恰当的第2步手术时机,遵循损伤控制的理念和无瘤原则等,可以有效降低围手术期并发症发生率和病死率,使ALPPS在选择性病人中安全可行。ALPPS并未改变肝癌的整体治疗格局,随着其理念、技术的不断进步和大样本前瞻性随机对照研究的逐步开展,ALPPS必将成为多学科综合治疗的一个重要组成部分,为中晚期肝癌整体疗效的提高提供基础。

Associating liver partition and portal vein ligation for staged hepatectomy（ALPPS）as a method of palliative treatment is used for patients with advanced hepatocellular carcinoma who cannot tolerate major hepatectomy due to an insufficient volume of future liver remnant. Until now,ALPPS is still a risky surgical procedure,and no reports on long-term outcomes has been published. ALPPS may be safe and feasible for selected patients after sufficient future liver remnant volume evaluations. The timing of the stage 2, the intraoperative damage control and tumor free operation are also important for the incidence of perioperative complications and mortality. It can believe that ALPPS will be demonstrated conclusively as an important part of the operation based multidisciplinary treatment of hepatocellular carcinoma by large-sample prospective randomized controlled studies.