ALPPS治疗剩余肝体积不足的中晚期肝癌的现状

Current status of ALPPS in the treatment of advanced liver cancer with insufficient future liver remnant

联合肝脏分隔和门静脉结扎的分阶段肝切除术（ALPPS）是近十年来肝脏外科的一大创举，2007年由德国Lang等首次报告。经典术式第一步为门静脉结扎和肝脏实质分隔，待剩余肝脏体积（FLR）增大到足够体积后进行右三叶肝切除术。随着ALPPS的不断发展，对肝实质分隔方法及隔离材料的改进提高了手术的安全性。ALPPS可在短期内增大FLR，因而术前精确评估FLR及肝脏储备功能，可有效避免术后发生肝功能衰竭；但该术式亦有较高的围手术期并发症发生率和病死率，这一问题如何解决及适应证选择是保证手术安全性的关键。我国80％以上原发性肝癌患者伴有肝硬化，严重影响FLR再生，究竟ALPPS是否适用于我国肝癌患者目前仍处于探索阶段，期待大宗病例的报道给出更客观的评价。

Associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） which represented a new two-steps liver resection procedures has been considered a revolutionary innovation for liver surgery technique in recent 10 years,it was first discovered by Professor Lang in Germany in 2007. The first step of the classic surgical procedures for portal vein ligation and liver parenchyma, until the future liver remnant （FLR） increased to a sufficient remnant then resect the right three-leaf liver. With the development of ALPPS, the method of hepatic parenehyma separation and isolation materials have been modified, which improves the safety of operation. ALPPS can speed up the regeneration of FLR in short period of time and therefore accurate assessment of FLR and liver reserve function preoperatively, which also can effectively prevent postoperative liver failure. However, it still remains controversy due to the high incidences of mobility and mortality perioperatively, how to solve this problem and chose the indications is the key.In China, 80% of liver cancer patients are associated with liver cirrhosis which the potential of FLR regeneration is limited. Whether ALPPS is applicable to the liver cancer patients in China remains to be further investigated,looking forward to a large number report of cases to give a more objective assessment.