Chan Albert C Y, Poon Ronnie T P, Lo Chung Mau
Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
World J Surg. 2015 Nov;39(11):2831-5. doi: 10.1007/s00268-015-3174-6.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a highly complex operation that demands a thorough understanding of the intrahepatic vascular anatomy and skills in parenchymal transection for the in situ split procedure. In order to minimize adhesion formation after the stage I operation and to avoid iatrogenic tumor rupture during right liver mobilization in large tumors, anterior approach appears to be a logical approach for the in situ split procedure. However, in contrast to the anterior approach adopted for the usual right hepatectomy, the right hepatic artery and biliary pedicle remain intact and undivided during the first operation. To address this issue, we hereby reported our experience of the modified 'anterior approach' for the ALPPS procedure that facilitates a complete in situ parenchymal split.
Prospectively collected data of 13 patients who underwent the ALPPS procedure by the modified anterior approach for hepatocellular carcinoma from October 2013 to October 2014 were reviewed.
The baseline future liver remnant volume (FLR) was 286 ml. The median tumor size was 6.0 cm. After a median of 8 days from stage I operation, the left FLR hypertrophied by 52.7 % in volume to 482 ml. All patients proceeded to second stage hepatectomy (extended right hepatectomy, n = 5; right hepatectomy, n = 6; right trisectionectomy, n = 2) without significant adhesion encountered. The overall morbidity and mortality rates were 7.7 % (n = 1) and 7.7 % (n = 1), respectively.
The modified anterior approach is safe and feasible for complete in situ split in the ALPPS procedure.
联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）是一种高度复杂的手术，需要对肝内血管解剖有透彻的了解以及在原位劈离手术中具备实质离断的技巧。为了将I期手术后的粘连形成降至最低，并避免在大肿瘤右肝游离过程中发生医源性肿瘤破裂，前路似乎是原位劈离手术的合理入路。然而，与常规右肝切除术所采用的前路不同，在首次手术过程中，右肝动脉和胆管蒂保持完整且未被切断。为解决这一问题，我们在此报告我们采用改良“前路”进行ALPPS手术的经验，该方法有助于实现完全的原位肝实质劈离。
回顾性分析2013年10月至2014年10月期间采用改良前路行ALPPS手术治疗肝细胞癌的13例患者的前瞻性收集数据。
未来肝残余体积（FLR）基线值为286 ml。肿瘤大小中位数为6.0 cm。I期手术后中位8天，左FLR体积增大52.7%，达到482 ml。所有患者均进行了II期肝切除术（扩大右肝切除术，n = 5；右肝切除术，n = 6；右三叶切除术，n = 2），未遇到明显粘连。总体发病率和死亡率分别为7.7%（n = 1）和7.7%（n = 1）。
改良前路在ALPPS手术中进行完全原位劈离是安全可行的。
