联合肝实质分隔和门静脉结扎的二步肝切除术式演变进展  

Progress of associating liver partition and portal vein ligation for staged hepatectomy evolution

作　　者：徐邦浩[1] 蓝祝晶 朱海[1] 王继龙 卢婷婷[2] 张灵[3] 郭雅[1] 彭民浩[1] 文张[1] XU Banghao;LAN Zhujing;ZHU Hai;WANG Jilong;LU Tingting;ZHANG Ling;GUO Ya;PENG Minhao;WEN Zhang(Department of Hepatobiliary Surgery,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,P.R.China;Department of Ultrasound,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,P.R.China;Department of Radiology,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,P.R.China)

机构地区：[1]广西医科大学第一附属医院肝胆外科,南宁530021 [2]广西医科大学第一附属医院超声科,南宁530021 [3]广西医科大学第一附属医院放射科,南宁530021

出　　处：《中国普外基础与临床杂志》2023年第7期870-876,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金地区科学基金项目(项目编号:82160128);国家自然科学基金青年科学基金项目(项目编号:81902983);2019年广西高校中青年教师科研基础能力提升项目(项目编号:2019KY0123)。

摘　　要：目的总结关于联合肝实质分隔和门静脉结扎的二步肝切除手术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)的术式演变和改进历程,为患者选择合适的手术方式总结经验。方法检索并查阅近年来国内外有关ALPPS术式演变改进的相关文献并进行综述。结果ALPPS诞生后的十余年里,在肝胆外科领域得到了快速发展,可促进剩余肝体积在短时间内迅速增长,可提高巨大肝肿瘤的可切除性并降低术后肝衰竭发生率,使中晚期且巨大肝癌患者获得根治性手术切除的机会。近年来,国内外专家对ALPPS术式进行了改进,主要集中在一期手术肝断面分隔操作和肝动脉血流限制上,包括部分ALPPS、射频消融ALPPS、止血带ALPPS、经肝动脉栓塞ALPPS、肝动脉戴戒限流术联合ALPPS,以及微创入路的腹腔镜ALPPS和机器人ALPPS。结论尽管ALPPS术式一直争议不断,但随着改良术式的不断进步与创新,以及腹腔镜和机器人在外科领域的成熟运用,使得ALPPS手术的创伤性进一步降低,术后并发症率和病死率逐渐下降。相信随着ALPPS手术技术的不断进步与改善,该术式的适应证范围和安全性将会得到进一步提升,为更多中晚期且巨大肝癌患者带来希望。Objective To summarize the progress of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)and evolution of surgical procedure improvement,so as to summarize experience in selecting appropriate surgical method for patients.Method The domestic and foreign literature on the evolution of ALPPS surgical procedure improvement in recent years was reviewed.Results In the decade since the emergence of ALPPS,the ALPPS had been rapidly developed in the hepatobiliary surgery.The ALPPS promoted a rapid increase in future liver remnant during a relatively shorter period to contribute to resectability of liver tumors and reduce the rate of postoperative liver failure,the patients with intermediate to advanced and huge liver cancer could obtain the surgical radical resection.In recent years,the domestic and foreign experts had refined the ALPPS procedure,which mainly focused on the operation of hepatic section separation and hepatic artery flow restriction in stageⅠsurgery,including partial ALPPS,radiofrequency ablation ALPPS,tourniquet ALPPS,transcatheter arterial embolization ALPPS,hepatic artery ringed and operation ALPPS,as well as laparoscopic ALPPS and robotic ALPPS with minimally invasive approach.Conclusions Despite the ongoing controversy over ALPPS,with the continuous progress and innovation of improved procedures and the utilization of laparoscope and robot in surgery, the trauma of ALPPS surgery has a further reduction,and the morbidity and mortality have gradually been decreased. It is believed that with the continuous advancement andimprovement of ALPPS surgery technology, the indications and safety of ALPPS will be further enhanced, bringing hopeto more patients with intermediate to advanced liver cancer with huge tumors.

关 键 词：肝癌 联合肝实质分隔和门静脉结扎的二步肝切除术 剩余肝脏体积 肝再生 

分 类 号：R735.7[医药卫生—肿瘤]