Brustia Raffaele, Scatton Olivier, Soubrane Olivier
Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Université Pierre et Marie Curie, Paris, France.
World J Surg. 2015 Dec;39(12):3023-7. doi: 10.1007/s00268-015-3209-z.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) got wide success among hepatic surgeons as an efficient way to shorten to 7 days from the 4 weeks interval of classic 2-staged hepatectomy. The main disadvantage of ALPPS is the onset of inflammatory adhesions, particularly on the hepatic pedicle region, previously dissected. The aim of the study is the evaluation of a resorbable collagen membrane (CM) indicated in the prevention of postoperative adhesions as an alternative to the use of a plastic bag (PB) during ALPPS procedure.
All patients undergoing ALPPS procedure in our department were prospectively included in a database. At the end of the first surgery, at least one resorbable CM (COVA+™, Biom'Up, France) was placed instead of a PB. Intraoperative adhesions during the second step and clinical short-term safety were assessed.
Ten patients with a mean age of 57.5 years underwent a 2-staged hepatectomy through ALPPS approach. At the second stage, 90 % of the patients experienced either grade-0 (no adhesion) or grade-I adhesions (mild adhesions easily divided). None of the reported complications were related to the use of the CM.
To our knowledge, this is the first clinical study evaluating the use of an anti-adhesion resorbable CM as a safe and efficient alternative to PB in ALPPS procedures.
联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）作为一种将经典两阶段肝切除术的4周间隔缩短至7天的有效方法，在肝脏外科医生中取得了广泛成功。ALPPS的主要缺点是炎症粘连的发生，尤其是在先前解剖过的肝蒂区域。本研究的目的是评估一种可吸收胶原膜（CM），其在预防术后粘连方面有应用前景，可在ALPPS手术中替代塑料袋（PB）使用。
前瞻性地将在我科接受ALPPS手术的所有患者纳入数据库。在第一次手术结束时，放置至少一片可吸收CM（COVA+™，Biom'Up，法国）替代PB。评估第二步手术中的术中粘连情况以及临床短期安全性。
10例平均年龄为57.5岁的患者通过ALPPS方法接受了两阶段肝切除术。在第二阶段，90%的患者出现0级（无粘连）或I级粘连（轻度粘连，易于分离）。报告的并发症均与CM的使用无关。
据我们所知，这是第一项评估在ALPPS手术中使用抗粘连可吸收CM作为PB的安全有效替代方法的临床研究。
