Department of Surgery, HBP Unit, Virgen de la Arrixaca University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain.
Department of Pathology, Virgen de la Arrixaca University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain.
Ann Surg. 2021 Jan 1;273(1):e22-e24. doi: 10.1097/SLA.0000000000004244.
We present a new variant of partial-ALPPS (p-ALPPS) "Tourniquet partial-ALPPS (Tp-ALPPS)", with the aim of reducing aggressiveness during stage 1.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) results in liver regeneration in only 9 days. Due to its high initial morbidity and mortality, less aggressive variants were designed.
A new surgical variant of ALPPS was designed consisting in introducing a Kelly forceps from the base of the liver, crossing the liver parenchyma through an avascular area. A 3-mm Vicryl (V152; Ethicon, Somerville, New Jersey, USA) tape is passed, and the tourniquet is then knotted. Six patients operated on by this new Tp-ALPPS surgical technique were compared to 6 patients operated on by Tourniquet ALPPS (T-ALPPS).
There were no differences in volume increase at 10 days. During stage 1, blood losses and transfusion rates tended to be lower in the Tp-ALPPS group, without statistical differences. Surgical time was shorter in the Tp-ALPPS group than in T-ALPPS (90 min versus 135 min) (p < 0.023). In stage 2, blood losses and transfusion were similar in both groups, but surgical time tended to be higher in the Tp-ALPPS group, which could be related to the surgical technique performed. There were no differences in morbidity and mortality.
Tp-ALPPS achieved a similar increase in volume as T-ALPPS but with a shorter stage 1 surgical and similar morbidity and mortality.
我们提出了一种新的部分联合肝脏离断和门静脉结扎的二步肝切除术（p-ALPPS）“止血带部分联合肝脏离断和门静脉结扎的二步肝切除术（Tp-ALPPS）”，旨在降低第一阶段的侵袭性。
联合肝脏离断和门静脉结扎的二步肝切除术（ALPPS）可在 9 天内实现肝脏再生。由于其初始发病率和死亡率较高，因此设计了侵袭性较低的变体。
设计了一种新的 ALPPS 手术变体，包括从肝脏底部引入凯利钳，穿过无血管区域的肝实质。穿过一条 3mm 的薇乔缝线（V152；Ethicon，Somerville，新泽西州，美国），然后结扎止血带。将这一新的 Tp-ALPPS 手术技术应用于 6 例患者，并与 6 例采用止血带 ALPPS（T-ALPPS）的患者进行比较。
两组患者在第 10 天的体积增加没有差异。在第一阶段，Tp-ALPPS 组的失血量和输血率较低，但无统计学差异。Tp-ALPPS 组的手术时间短于 T-ALPPS 组（90 分钟对 135 分钟）（p<0.023）。在第二阶段，两组患者的失血量和输血情况相似，但 Tp-ALPPS 组的手术时间倾向于较高，这可能与所采用的手术技术有关。两组患者的发病率和死亡率无差异。
Tp-ALPPS 实现了与 T-ALPPS 相似的体积增加，但第一阶段手术时间更短，发病率和死亡率相似。
