计划性肝切除：选择门静脉栓塞还是联合肝脏分隔和门静脉结扎的二步肝切除？

Planned hepatectomy： Selection of portal vein embolization and associating liver partition and portal vein ligation for staged sepatectomy

手术切除是治疗肝癌的首选方法。对不宜一期手术切除的患者，通过人为诱导拟保留的肝组织增生、肥大，拟切除的肝脏萎缩，可使不可切除变为可以切除。联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）作为一种目前尚处于初期探索阶段的手术方案，成为肝胆外科热议的话题，尽管在世界范围内仍存在着巨大争议，但是值得进一步研究和探索。笔者分析认为，若能制定个性化的治疗方案，同时制定严格、合理的多中心临床试验，ALPPS可以使传统认为不可切除的肝胆肿瘤患者，获得安全、有效的根治性手术机会。

Surgical resection is the first choice for liver cancer therapy. In order to transform the unresectable part into reseetable one, surgeons manage to ensure adequate liver re- serves by making the wanted liver tissue become hypertrophy and let the unwanted one become atrophy. However, though ALPPS （associating liver partition and portal vein ligation for staged sepatectomy） as an alternative operation plan in its initial devel- oping stage now becomes a hot topic, it is still under great con- troversy. The author believes that it is imperative to draw up a personalized plan and carry out a strict and reasonable muhi- center-clinical trial for those patients to get an opportunity to conduct a safe and effective operation.