肝切除联合Ⅱ~Ⅲ段部分肝移植的延期全肝切除手术的历史与现状

The history and current status of resection and partial liver segmentⅡ/Ⅲtransplantation with delayed total hepatectomy

肝切除联合Ⅱ~Ⅲ段部分肝移植的延期全肝切除手术(RAPID)是一种结合了联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)和辅助性肝移植各自优势的手术,主要用于治疗以不可切除结直肠癌肝转移为代表的非硬化性肝脏疾病以及合并门静脉高压的肝脏硬化性疾病。该手术是在肝移植治疗不可切除结直肠癌肝转移疗效取得明显进步的背景下诞生的,旨在解决供肝短缺和肝源分配问题。RAPID手术的步骤包括一期受体左肝切除+供体左外叶部分肝移植+移植物门静脉血流调控;手术间期监测移植物体积的增长、功能的增加和二期受体一期手术时残留的病肝切除手术。RAPID手术的发展包括活体供肝RAPID手术(LD-RAPID)和脾切除联合Ⅱ~Ⅲ段部分肝脾窝异位辅助肝移植的延期全肝切除术(RAVAS)。然而与经典肝移植相比,RAPID手术还需要更多的经验积累和严格的风险管理。多中心的临床试验和远期术后随访对于充分认识RAPID手术具有重要意义。

Resection and partial liver segmentⅡ/Ⅲtransplantation with delayed total hepatectomy(RAPID)is a surgery that combines the advantages of two-step hepatectomy with associating liver partition and portal vein ligation(ALPPS)and auxiliary liver transplantation.The surgery is mainly used to treat noncirrhotic liver diseases such as nonresectable colorectal liver metastases(nrCRLM)and cirrhotic liver diseases with portal hypertension.The concept and procedure of this surgery was innovated with a dramatic improvement of treatment of nrCRLM by liver transplantation.The aim of this surgery is to alleviate the shortage of liver allograft and the allocation of donor livers.The protocol of the RAPID includes left liver resection,implantation of left lateral graft,and modulation of portal flow to the graft in the phase 1.During the interphase,regeneration of volume and function of the liver graft is monitored.Remnant right liver resection is completed in the phase 2.The technical development of RAPID includes living donor-RAPID and RAVAS.However,compared with classical liver transplantation,RAPID requires more experience accumulation and strict risk management.It is of most importance to evaluate RAPID procedure by multi-center clinical trials and long-term postoperative follow-up.