Sparrelid Ernesto, Hasselgren Kristina, Røsok Bård Ingvald, Larsen Peter Nørgaard, Schultz Nicolai Aagaard, Carling Ulrik, Fallentin Eva, Gilg Stefan, Sandström Per, Lindell Gert, Björnsson Bergthor
Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Department of Surgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Hepatobiliary Surg Nutr. 2021 Jan;10(1):1-8. doi: 10.21037/hbsn.2019.10.36.
The role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in comparison to portal vein embolization (PVE) is debated. The aim of this study was to compare successful resection rates (RR) with upfront ALPPS PVE with rescue ALPPS on demand and to compare the hypertrophy of the liver between ALPPS and PVE plus subsequent rescue ALPPS.
A retrospective analysis of all patients treated with PVE for colorectal liver metastasis (CRLM) or ALPPS (any diagnosis, rescue ALPPS included) at five Scandinavian university hospitals during the years 2013-2016 was conducted. A Chi-square test and a Mann-Whitney U test were used to assess the difference between the groups. A successful RR was defined as liver resection without a 90-day mortality.
A total of 189 patients were included. Successful RR was in 84.5% of the patients with ALPPS upfront and in 73.3% of the patients with PVE and rescue ALPPS on demand (P=0.080). The hypertrophy of the future liver remnants (FLRs) with ALPPS upfront was 71% (48-97%) compared to 96% (82-113%) after PVE and rescue ALPPS (P=0.010).
Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on demand. The sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.
相较于门静脉栓塞术（PVE），联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）的作用存在争议。本研究旨在比较直接行ALPPS与按需行PVE及挽救性ALPPS的成功切除率（RR），并比较ALPPS与PVE加后续挽救性ALPPS之间肝脏的肥大情况。
对2013年至2016年期间在五家斯堪的纳维亚大学医院接受PVE治疗结直肠癌肝转移（CRLM）或ALPPS（包括任何诊断、挽救性ALPPS）的所有患者进行回顾性分析。采用卡方检验和曼-惠特尼U检验评估组间差异。成功RR定义为无90天死亡率的肝切除术。
共纳入189例患者。直接行ALPPS的患者成功RR为84.5%，按需行PVE及挽救性ALPPS的患者为73.3%（P = 0.080）。直接行ALPPS时未来肝残余（FLR）的肥大率为71%（48 - 97%），而PVE及挽救性ALPPS后为96%（82 - 113%）（P = 0.010）。
直接行ALPPS比按需行PVE及挽救性ALPPS的成功RR略高。PVE与ALPPS的序贯联合比直接行ALPPS导致更高的总体肥大程度。
