Liver Transplant Unit and General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Updates Surg. 2012 Sep;64(3):167-72. doi: 10.1007/s13304-012-0175-y. Epub 2012 Aug 18.
Surgical resection is the best option for prolonged survival in patients with primary or secondary liver tumors. A sufficient future liver remnant (FLR) volume is needed to prevent post-hepatectomy liver failure (PHLF). With the aim of increasing FLR, a new two-step technique has been recently developed. Our aim is to report our initial experience with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique. Analysis was conducted of ten patients previously considered locally unresectable because of small FLR. During first surgical step liver parenchymal partition and portal vein ligation was performed. Seven days after the first procedure, once volumetric and functional studies have demonstrated an appropriate FLR volume, the resection of the deportalized hemiliver was achieved. This technique was successfully performed in all ten patients (feasibility 100 %). Six were male with mean age of 55.2 years (range 39-77). Mean preoperative FLR volume and FLR/total liver volume were 408.4 ml and 27.8 %. Mean postoperative FLR volume was 733 ml representing a mean volume increase of 325 ml or 82 % (range 31-140) (p < 0.0001). All resections were R0 (4 right hepatectomies, 5 right trisectionectomies and 1 left trisectionectomy). There were two grade A post-hepatectomy liver failures. Morbidity was 40 % and mortality 0 %. With a mean follow-up of 187 days, disease-free survival and overall survival were 80 and 100 %, respectively. ALPPS induces a great and fast FLR hypertrophy allowing R0 resections in patients otherwise considered unresectable because of small FLR volume, without severe PHLF and low mortality in experience centers. Further experience is needed to determine long-term outcomes.
手术切除是原发性或继发性肝肿瘤患者获得长期生存的最佳选择。需要有足够的剩余肝体积（FLR）来预防肝切除术后肝衰竭（PHLF）。为了增加 FLR，最近开发了一种新的两步技术。我们的目的是报告我们在联合肝脏离断和门静脉结扎的两阶段肝切除术（ALPPS）技术方面的初步经验。对 10 例先前因 FLR 较小而被认为局部不可切除的患者进行了分析。在第一手术步骤中，进行肝实质离断和门静脉结扎。第一次手术后 7 天，一旦进行了体积和功能研究，显示出适当的 FLR 体积后，进行离断门静脉的半肝切除术。该技术在所有 10 例患者中均成功实施（可行性 100%）。其中 6 例为男性，平均年龄 55.2 岁（范围 39-77 岁）。术前 FLR 体积和 FLR/总肝体积的平均值分别为 408.4ml 和 27.8%。术后平均 FLR 体积为 733ml，代表平均增加 325ml 或 82%（范围 31-140）（p<0.0001）。所有切除均为 R0（4 例右半肝切除术，5 例右三叶切除术和 1 例左三叶切除术）。有 2 例 A 级肝切除术后肝衰竭。发病率为 40%，死亡率为 0%。平均随访 187 天，无病生存率和总生存率分别为 80%和 100%。ALPPS 可引起巨大而快速的 FLR 肥大，使 R0 切除术成为可能，否则由于 FLR 体积小，患者无法进行可切除性手术，且在经验丰富的中心中不会发生严重的 PHLF 和低死亡率。需要进一步的经验来确定长期结果。
