肝切除联合部分肝移植延期全肝切除术的发展与应用

Development and application of resection and partial liver transplantation with delayed total hepatectomy

肝脏是结直肠癌常见的转移部位,多数结直肠癌肝转移患者无法行根治性肝切除术.肝移植可为高选择性不可切除结直肠癌肝转移(u-CRLM)患者带来生存获益,但供肝短缺严重制约其在u-CRLM中的开展.肝切除联合部分肝移植的延期全肝切除术(RAPID)是近年新发展的肝移植手术方式,其通过创新性结合辅助式肝移植以及联合肝脏分隔和门静脉结扎二步肝切除术,安全、有效地利用小体积部分肝移植物治疗u-CRLM.在RAPID中,门静脉、肝静脉等血管的重建是手术重点,门静脉压力和流量的控制是手术难点与成功关键.RAPID结合活体肝移植发展出活体RAPID,且RAPID应用范围也扩展到肝硬化、肝癌等原发性肝脏疾病.RAPID手术难度大、步骤多,目前仅处于探索阶段.笔者查阅相关文献,围绕RAPID的发展历程,全面概述其手术步骤及注意要点,并对其应用进行探讨.

Liver is a common site for distant metastasis of colorectal cancer and a large proportion of patients with colorectal liver metastasis cannot receive the radical hepatectomy.Liver transplantation has been proven to bring a survival benefit in highly selected unresectable colorectal liver metastasis(u-CRLM)patients,but the shortage of donor liver severely restricts its application.Resection and partial liver transplantation with delayed total hepatectomy(RAPID)is a newly developed liver transplantation procedure,which innovatively combined auxiliary liver transplantation and associating liver partition and portal vein ligation for staged hepatectomy.With the small and partial liver graft,RAPID can cure u-CRLM safely and effectively.In RAPID,the reconstruction of portal vein and hepatic vein is the key point,while the control of portal vein pressure and flow is the difficulty and also the key for success.Thereafter,living donor-RAPID is created by combing RAPID with living donor liver transplantation.Besides,the application of RAPID also extends to other primary liver diseases,including liver cirrhosis and liver cancer.RAPID is difficult,complex and under an exploratory stage at present.In this paper,based on the developing process of RAPID,the authors give a comprehensive overview of its surgical procedures and key points,and discuss its potential application area.