ALPPS治疗肝细胞癌10年回望:永恒的理念 慎选的术式  

Ten-year retrospect of ALPPS in the treatment of hepatocellular carcinoma:an eternal concept with cautious technologic choice

作　　者：洪德飞[1] 彭淑牖[2] 刘允怡[3] Defei Hong;Shuyou Peng;Lau Wanyee(Department of General Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310006,China;Chinese University of Hong Kong,Hong Kong,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院普通外科,杭州310016 [2]浙江大学医学院附属第二医院肝胆胰外科,杭州310006 [3]香港中文大学医学院,香港999077

出　　处：《中华外科杂志》2022年第2期113-116,共4页Chinese Journal of Surgery

摘　　要：联合肝脏分割和门静脉结扎二步肝切除术(ALPPS)及其改进术式治疗余肝体积(FLR)不足的原发性肝细胞癌(HCC)的近10年的临床实践表明,其围手术期并发症发生率和病死率仍偏高,远期疗效改善不明显。主要原因有:患者在短期内需承受二次肝脏外科手术的打击;FLR不足的HCC多为中晚期,术后易发生复发和转移;ALPPS仅实现了外科技术上的切除,并未实现肿瘤生物学上的切除。既往研究结果证明,中晚期HCC经局部治疗实现降期后再切除,其5年生存率与早期HCC切除后相当。因此,要提高FLR不足HCC患者的远期生存率,应倡导以肿瘤生物学转化为先、FLR增生为后的双转化策略和技术。靶向、免疫治疗联合局部治疗有望大幅提高转化率。回望ALPPS治疗HCC 10年的发展历程,留下的是促使FLR快速增生的永恒理念,慎选的是高代价、高风险、远期疗效提升不理想的外科术式。Clinical practice using associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)or its modified procedures in treatment of primary hepatocellular carcinoma(HCC)with insufficient future liver remnant(FLR)in the past 10 years has failed to meet our expectations both in achieving decreased perioperative complications and mortality.The efficacy of ALPPS in improving long-term survival outcome of HCC still remains poor.Due to the trauma of two surgery within a short period,and patients with inadequate FLR are all diagnosed at advanced disease stages,ALPPS can only achieve surgical rather than biological tumor-curability.Previous studies have demonstrated comparable 5-year survival rates between early and advanced stages of HCC who underwent regional treatments.Therefore,tumor biological conversion is the key strategy prior to liver remnant volume conversion in improving treatment outcomes for HCC patients with insufficient FLR.Target therapy,immunotherapy together with locally treatment were expected to improve the conversion efficacy.Looking back at the development of ALPPS for the last decade,the rapid proliferation of FLR should be passed on,while the technology costs high risks and result in poor long-term outcome must be cautiously selected.

关 键 词：肝肿瘤 外科手术 联合肝脏分隔和门静脉结扎二步肝切除术 余肝不足 门静脉栓塞 

分 类 号：R735.7[医药卫生—肿瘤]