损伤控制理念下联合肝脏分隔和门静脉结扎的二步肝切除术手术方式改进

Variations and adaptations of associating liver partition and portal vein ligation for staged hepatectomy with the gui- dance of damage control surgery

联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）被用于治疗剩余肝脏体积不足的中晚期肝癌患者，提高了极量肝切除术的安全性和中晚期肝癌手术切除率。但由于该手术方式具有较高的围术期并发症发生率和病死率，限制了其应用，故以损伤控制为核心的手术方式改进需求尤为迫切。目前，以腹腔镜微创外科为主导，联合RFA、微波消融、捆绑、门静脉栓塞等多种技术的改进可能有助于降低ALPPS的创伤和并发症发生率，使患者获益，但最终结论仍有待大样本前瞻性对照研究予以证实。

Associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） is used for patients with advanced hepatocellular carcinoma who cannot tolerate major hepatectomy due to an insufficient future liver remnant, but the morbidity and mortality rate in the perioperative period are still high. Available studies indicate that damage control surgery variations such as laparoscopic procedure and associating radiofrequency/microwave ablation/liver tourniquet and portal vein ligation could improve the morbidity and mortality associated with ALPPS, as could portal vein embolization. However, randomized controlled trials are needed to determine benefits in technical variations.