ALPPS临床应用面临的问题及其解决策略

Problems and strategies in clinical application of associating liver partition and portal vein ligation for staged hepatectomy

联合肝实质分隔和门静脉结扎的二步肝切除术(ALPPS)可在短期内增大剩余肝脏体积,理论上可为剩余肝脏体积不足的肝肿瘤患者提供手术切除机会。然而,ALPPS的临床应用效果目前尚无定论。现有报道提示,ALPPS具有较高的围手术期并发症发生率和病死率,且长期肿瘤学获益尚不明确。解决以上问题是推广应用该术式的关键。本文从ALPPS适应证选择、肝脏储备功能评估、第二步手术时机选择、手术方式演变、与门静脉栓塞或门静脉结扎+二步法肝切除比较等热点和难点问题进行分析和阐述。

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)can speed up the regeneration of future liver remnant(FLR)in short period of time,and offer a chance for surgical resection for patients without sufficient FLR.However,ALPPS still remains controversy due to its high perioperative morbidity and mortality,as well as the uncertain long-term oncological benefits.How to solve these problems is the key to ensure the safety of surgery.This article focus on the indication selection,liver function reserve evaluation and timing to perform the second stage surgery,surgical mode evolution and comparison with portal venous embolization/portal venous ligation+two-stage hepatectomy.