General, Visceral and Transplantation Surgery, University Hospital Tuebingen, Tuebingen, Germany.
J Gastrointest Surg. 2013 May;17(5):956-61. doi: 10.1007/s11605-012-2132-y. Epub 2013 Jan 4.
To induce rapid hepatic hypertrophy and to reduce post-hepatectomy liver failure (PHLF), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients with a limited future liver remnant. The aim of this study was to further assess the perioperative risk of this procedure and its specific indications.
The study was performed between November 2010 and April 2012 for patients undergoing right trisectionectomy by the ALPPS approach. Liver volume, intra- and postoperative complications, including PHLF, and residual tumour status were compared for patients with different diagnoses.
The interval between two operations in nine patients undergoing ALPPS was 13 days (median). Sufficient hepatic hypertrophy was achieved with a volume gain of 87.2 % (median). All patients underwent right trisectionectomy without residual tumours. In contrast to six patients with uneventful intra- and postoperative course, bile leak, vancomycin-resistant enterococcus infection, PHLF and sepsis developed in two of three patients with hilar cholangiocarcinoma as the preoperative diagnosis.
ALPPS leads to sufficient hepatic hypertrophy within 2 weeks, avoiding PHLF in most patients. In patients with hilar cholangiocarcinoma, ALPPS should be applied with extreme caution due to high morbidity and mortality.
为了诱导快速肝肥大并减少肝切除术后肝衰竭（PHLF），对于未来肝脏残余量有限的患者，最近已经开发了联合肝脏分隔和门静脉结扎的分期肝切除术（ALPPS）。本研究的目的是进一步评估该手术的围手术期风险及其特定适应证。
该研究于 2010 年 11 月至 2012 年 4 月期间，对接受 ALPPS 方法右三叶切除术的患者进行了研究。比较了不同诊断患者的肝体积、围手术期并发症（包括 PHLF）和残余肿瘤状况。
9 例接受 ALPPS 的患者两次手术之间的间隔为 13 天（中位数）。实现了足够的肝肥大，体积增加了 87.2%（中位数）。所有患者均无残余肿瘤，行右三叶切除术。与六例围手术期无并发症的患者相比，以肝门部胆管癌为术前诊断的三例患者中有两例出现胆漏、万古霉素耐药肠球菌感染、PHLF 和脓毒症。
ALPPS 在 2 周内导致足够的肝肥大，避免了大多数患者的 PHLF。对于肝门部胆管癌患者，由于发病率和死亡率高，ALPPS 的应用应格外小心。
