与传统分期肝切除术相比，联合肝脏分隔和门静脉结扎的分期肝切除术可实现更大程度的肥大，但要付出更高的代价？
Greater hypertrophy can be achieved with associating liver partition with portal vein ligation for staged hepatectomy compared to conventional staged hepatectomy, but with a higher price to pay?
作者信息
Chia Daryl K A, Yeo Zachery, Loh Stanley E K, Iyer Shridhar Ganpathi, Bonney Glenn Kunnath, Madhavan Krishnakumar, Kow Alfred W C
机构信息
Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
出版信息
Am J Surg. 2018 Jan;215(1):131-137. doi: 10.1016/j.amjsurg.2017.08.013. Epub 2017 Aug 26.
BACKGROUND
Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) and conventional staged hepatectomy (CSH) are options for patients with unresectable liver tumors due to insufficient future liver remnant (FLR).
METHODS
A retrospective comparison of clinical data, liver volumetry and surgical outcomes between 10 ALPPS and 29 CSH patients was performed.
RESULTS
Patient demographics and disease characteristics were similar between both groups. ALPPS induced superior FLR growth (ALPPS vs. CSH, 48.1% (IQR 39.4-96.9%) vs. 11.8% (IQR 4.3-41.9%), p = 0.013). However, post-operative day 5 international normalized ratio (INR) (ALPPS vs. CSH, 1.6 (IQR 1.5-1.8) vs. 1.4 (IQR 1.3-1.6), p = 0.015) and rate of post-hepatectomy liver failure (ALPPS vs. CSH, 25 vs. 0%, p = 0.032) was higher in the ALPPS group. 90-day mortality (ALPPS vs. CSH, 12.5% vs. 0%, p = 0.320) was similar in both groups.
CONCLUSION
ALPPS was superior in inducing FLR growth but associated with increased post-hepatectomy liver failure compared to CSH.
背景
联合肝脏分隔与门静脉结扎的分期肝切除术（ALPPS）和传统分期肝切除术（CSH）是针对因未来肝脏残余量（FLR）不足而无法切除的肝肿瘤患者的治疗选择。
方法
对10例接受ALPPS和29例接受CSH的患者的临床数据、肝脏容积测定和手术结果进行回顾性比较。
结果
两组患者的人口统计学和疾病特征相似。ALPPS能使FLR更好地生长（ALPPS组与CSH组相比，48.1%（四分位间距39.4 - 96.9%） vs. 11.8%（四分位间距4.3 - 41.9%），p = 0.013）。然而，ALPPS组术后第5天的国际标准化比值（INR）（ALPPS组与CSH组相比，1.6（四分位间距1.5 - 1.8） vs. 1.4（四分位间距1.3 - 1.6），p = 0.015）和肝切除术后肝衰竭发生率（ALPPS组与CSH组相比，25% vs. 0%，p = 0.032）更高。两组的90天死亡率相似（ALPPS组与CSH组相比，12.5% vs. 0%，p = 0.320）。
结论
与CSH相比，ALPPS在促进FLR生长方面更具优势，但与肝切除术后肝衰竭发生率增加有关。
Zotero 插件