Lang S A, Loss M, Schlitt H J
Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Deutschland.
Zentralbl Chir. 2014 Apr;139(2):212-9. doi: 10.1055/s-0032-1328742. Epub 2013 Sep 10.
The combination of right portal vein ligation with complete parenchyma dissection ("in-situ split", ISS) for rapid hypertrophy induction of the left-lateral liver lobe is a novel strategy to convert primarily irresectable liver tumours into a resectable stage. Available data so far show a 60-80 % growth induction of the remnant liver within 7(- 9) days. Certainly, a novel concept that comprises two operations within a very short time period raises questions. Based on the very few literature reports that have been published so far, as well as our own experience, we here discuss technical issues such as the use of a plastic sheet on the resection margin, the possibility of laparoscopic dissection and the timing of the second operation. Moreover, aspects of the preoperative diagnostic work-up that is necessary are assessed. Finally, open questions, e.g., concerning the influence of preoperative chemotherapy and the use of ISS in patients with cirrhosis are evaluated. In summary, the assessment of chances and risks of this novel concept with regard to indication and technical issues helps to provide the potentially curative option of the "in-situ split" procedure to more patients with marginal or even irresectable liver tumours.
右门静脉结扎联合完整肝实质离断术（“原位劈离”，ISS）用于快速诱导肝左外叶肥大，是一种将原本不可切除的肝肿瘤转化为可切除阶段的新策略。目前可得的数据显示，在7（-9）天内残余肝脏的生长诱导率为60%-80%。当然，一个在很短时间内包含两次手术的新概念引发了一些问题。基于目前已发表的极少文献报道以及我们自己的经验，我们在此讨论一些技术问题，如在切除边缘使用塑料片、腹腔镜离断的可能性以及第二次手术的时机。此外，还评估了必要的术前诊断检查方面。最后，对一些未解决的问题进行了评估，例如术前化疗的影响以及ISS在肝硬化患者中的应用。总之，对这一新概念在适应证和技术问题方面的机会和风险进行评估，有助于为更多患有边缘性甚至不可切除肝肿瘤的患者提供“原位劈离”手术这一潜在的治愈选择。
