Sanjeevi Srinivas, Sparrelid Ernesto, Gilg Stefan, Jonas Eduard, Isaksson Bengt
Department of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden.
Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
ANZ J Surg. 2018 Jul-Aug;88(7-8):760-764. doi: 10.1111/ans.14252. Epub 2017 Dec 14.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a two-stage procedure most frequently applied in the setting of an extended right-sided hemi-hepatectomy. Initial reports of high mortality have sparked debate regarding the safety and efficacy of the procedure. We describe a higher incidence of early post-operative bile duct strictures after ALPPS, a complication rarely seen after conventional liver resection.
An institutional review was conducted to assess the incidence of post-operative biliary strictures following conventional right-sided or extended right-sided hemi-hepatectomy and ALPPS. Patient demographics and operative data were obtained from the patient database of Karolinska University Hospital.
Between 2010 and 2015, 528 hemi-hepatectomies or extended hemi-hepatectomies were performed, of which 500 were conventional liver resections and 28 were ALPPS. The incidence of post-operative biliary stricture was 10.7% (n = 3) following ALPPS, 1.4% (n = 2) following extended right-sided hepatectomy (P = 0.023; OR = 8.46; 95% CI 1.35-53.2) and 1.1% following formal right-sided hepatectomy (P = 0.004; OR = 11.0; 95% CI 2.11-57.6). All biliary strictures were at the level of the hilum affecting the left hepatic duct. Pre-operative comorbidity was less in the ALPPS group and post-operative complications were more severe following ALPPS.
Iatrogenic biliary strictures following conventional liver resection is an uncommon complication. It does, however, occur more frequently following ALPPS and is associated with an increased morbidity. Caution should therefore be exercised when dividing the right hilar pedicle at stage 2 of ALPPS.
联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）是一种主要应用于扩大右半肝切除术的两阶段手术。最初关于高死亡率的报道引发了对该手术安全性和有效性的争论。我们描述了ALPPS术后早期胆管狭窄的发生率较高，这是传统肝切除术后很少见的一种并发症。
进行一项机构回顾，以评估传统右半肝切除术或扩大右半肝切除术及ALPPS术后胆管狭窄的发生率。患者人口统计学和手术数据来自卡罗林斯卡大学医院的患者数据库。
2010年至2015年期间，共进行了528例半肝切除术或扩大半肝切除术，其中500例为传统肝切除术，28例为ALPPS。ALPPS术后胆管狭窄的发生率为10.7%（n = 3），扩大右半肝切除术后为1.4%（n = 2）（P = 0.023；OR = 8.46；95% CI 1.35 - 53.2），标准右半肝切除术后为1.1%（P = 0.004；OR = 11.0；95% CI 2.11 - 57.6）。所有胆管狭窄均位于肝门水平，影响左肝管。ALPPS组术前合并症较少，术后并发症更严重。
传统肝切除术后医源性胆管狭窄是一种罕见的并发症。然而，它在ALPPS术后更频繁发生，且与发病率增加相关。因此，在ALPPS第二阶段分离右肝门蒂时应谨慎操作。
