Department of Surgery and Liver Transplantation Unit, Ankara University School of Medicine, Ankara, Turkey.
Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Japan.
Int J Surg. 2020 Oct;82S:97-102. doi: 10.1016/j.ijsu.2020.06.045. Epub 2020 Jul 7.
Perihilar cholangiocarcinoma (PHCC) has been a great challenge for surgeons, requiring advanced skills and expertise and was often associated with high morbidity and mortality. Resectability rates are up to 75% even in experienced centers. In patients with PHCC, radical liver and bile duct resection aiming R0 surgical margins offers the best long-term survival. Therefore, extensive resections with low FLR are commonly needed and PVE is offered to induce remnant liver hypertrophy for a long period. Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) is considered a promising approach inducing rapid remnant hypertrophy to prevent dropouts due to complications or tumor progression and increase resectability. Although poor results were reported initially, refinements in technique and risk adjustment of patient selection improved outcomes. The procedure is still under debate for the indication of PHCC. This article reviews the current literature on ALPPS in treatment of perihilar and intrahepatic cholangiocarcinoma.
肝门部胆管癌（PHCC）一直是外科医生面临的巨大挑战，需要高超的技能和专业知识，且常伴有较高的发病率和死亡率。即使在经验丰富的中心，其可切除率也高达 75%。对于 PHCC 患者，为获得 R0 手术切缘，根治性肝和胆管切除术是最佳的长期生存方法。因此，通常需要进行广泛的低剩余肝脏体积（FLR）切除，门静脉栓塞术（PVE）用于诱导残余肝脏长期增生。联合肝脏离断和门静脉结扎的分阶段肝切除术（ALPPS）被认为是一种有前途的方法，可以通过快速诱导残余肝增生来预防因并发症或肿瘤进展而导致的脱落，并提高可切除性。尽管最初报道的结果较差，但随着技术的改进和对患者选择的风险调整，其结果得到了改善。该手术在 PHCC 的适应证方面仍存在争议。本文综述了关于 ALPPS 治疗肝门部和肝内胆管癌的现有文献。
