Liver Surgery and Liver Transplant Unit, Faculty of Medicine, University of Murcia, El Palmar, Murcia, Spain.
Br J Surg. 2014 Aug;101(9):1129-34; discussion 1134. doi: 10.1002/bjs.9547. Epub 2014 Jun 19.
In staged liver resections, associating liver partition and portal ligation for staged hepatectomy (ALPPS) achieves sufficient hypertrophy of the future liver remnant (FLR) in 7 days. This is based on portal vein ligation and transection, and on occlusion of intrahepatic collaterals. This article presents a new surgical technique for achieving rapid hypertrophy of the FLR, which also involves adding intrahepatic collateral occlusion to portal vein transection.
Patients scheduled for two-stage liver resection for primary or secondary liver tumours, in whom the FLR was considered too small, were enrolled prospectively. In the first stage, a tourniquet was placed around the parenchymal transection line, and the right portal vein was ligated and cut (associating liver tourniquet and portal ligation for staged hepatectomy, ALTPS). The tourniquet was placed on the umbilical ligament if a staged right trisectionectomy was planned, and on Cantlie's line for staged right hepatectomy.
From September 2011, 22 ALTPS procedures were carried out (right trisectionectomy in 15, right hepatectomy in 7). Median FLR at 7 days increased from 410 to 700 ml (median increase 61 (range 33-189) per cent). The median duration of the first stage was 125 min and no patient received a blood transfusion. The median duration of the second stage was 150 min and five patients required a blood transfusion. Fourteen patients had complications, most frequently infected collections, and five patients developed postoperative liver failure. Two patients died.
The ALTPS technique achieved adequate hypertrophy of the FLR after 7 days. It may provide a less aggressive modification of the ALPPS procedure.
在分期肝切除术中，联合肝脏分隔和门静脉结扎的分期肝切除术（ALPPS）可在 7 天内使未来肝残存量（FLR）充分肥大。这是基于门静脉结扎和切断，以及肝内侧支闭塞。本文提出了一种新的手术技术，可使 FLR 迅速肥大，该技术还涉及门静脉切断时肝内侧支闭塞。
前瞻性纳入因 FLR 过小而被认为不适合行两阶段肝切除术的原发性或继发性肝肿瘤患者。在第一阶段，在实质切开线周围放置止血带，结扎并切断右门静脉（联合肝脏止血带和门静脉结扎的分期肝切除术，ALTPS）。如果计划行分期右三叶切除术，则在脐韧带上放置止血带，如果计划行分期右半肝切除术，则在 Cantlie 线上放置止血带。
自 2011 年 9 月以来，共实施了 22 例 ALTPS 手术（右三叶切除术 15 例，右半肝切除术 7 例）。7 天 FLR 中位数从 410 增加到 700ml（中位数增加 61%（范围 33-189%））。第一阶段的中位时间为 125 分钟，没有患者接受输血。第二阶段的中位时间为 150 分钟，5 例患者需要输血。14 例患者发生并发症，最常见的是感染性积液，5 例患者发生术后肝功能衰竭。2 例患者死亡。
ALTPS 技术在 7 天后使 FLR 获得了足够的肥大。它可能是一种更具侵袭性的 ALPPS 手术的改良术式。
