Edmondson Matthew J, Sodergren Mikael H, Pucher Philip H, Darzi Ara, Li Jun, Petrowsky Henrik, Campos Ricardo Robles, Serrablo Alejandro, Jiao Long R
Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Surgery. 2016 Apr;159(4):1058-72. doi: 10.1016/j.surg.2015.11.013. Epub 2015 Dec 31.
Our aim was to review variations from the originally described associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure and relevant clinical outcomes.
A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (ie, PRISMA) guidelines. A search of PubMed and Google Scholar was conducted until March 2015. Inclusion criteria were any publications reporting technical variations and descriptions of ALPPS. Exclusion criteria were insufficient technical description, data repeated elsewhere, or data that could not be accessed in English.
Initial search results returned 790 results; 46 studies were included in the final qualitative analysis. There were several alternatives described to the first stage of complete parenchymal split. Variations included partial ALPPS (partial split; hypertrophy of future liver remnant [FLR] 80-90%), radiofrequency-assisted liver partition and portal vein ligation (mean FLR hypertrophy 62%), laparoscopic microwave ablation and portal vein ligation (FLR hypertrophy 78-90%), associating liver tourniquet and portal ligation for staged hepatectomy (median FLR hypertrophy 61%), and sequential associating liver tourniquet and portal ligation for staged hepatectomy (FLR hypertrophy 77%) with a potential decrease in morbidity particularly after stage I. We analyzed several other variations, including considerations for segment IV, operative maneuvers, use of laparoscopy, identification of biliary complications, and liver containment.
The current literature demonstrates a large variability in techniques of ALPPS that limits meaningful statistical comparisons of outcomes. Not physically splitting the liver at the first stage may decrease morbidity; however, randomized controlled trials are needed to determine benefits in technical variations.
我们的目的是回顾最初描述的联合肝脏分割和门静脉结扎分期肝切除术（ALPPS）手术的变异情况及相关临床结局。
按照系统评价和Meta分析的首选报告项目（即PRISMA）指南进行系统评价。检索PubMed和谷歌学术，截止至2015年3月。纳入标准为任何报告ALPPS技术变异及描述的出版物。排除标准为技术描述不充分、在其他地方重复的数据或无法获取英文版本的数据。
初步检索结果返回790条；46项研究纳入最终定性分析。对于第一阶段完全实质分割有几种替代方法被描述。变异包括部分ALPPS（部分分割；未来肝残余[FLR]肥大80 - 90%）、射频辅助肝脏分割和门静脉结扎（平均FLR肥大62%）、腹腔镜微波消融和门静脉结扎（FLR肥大78 - 90%）、联合肝脏束带和门静脉结扎分期肝切除术（中位FLR肥大61%）以及序贯联合肝脏束带和门静脉结扎分期肝切除术（FLR肥大77%），特别是在I期后发病率可能降低。我们分析了其他几种变异，包括对IV段的考虑、手术操作、腹腔镜的使用、胆系并发症的识别以及肝脏容纳情况。
当前文献表明ALPPS技术存在很大变异性，这限制了对结局进行有意义的统计学比较。在第一阶段不进行肝脏物理分割可能会降低发病率；然而，需要随机对照试验来确定技术变异的益处。
