Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
Research Program "Else Kröner-Forschungskolleg AntiAge", Jena University Hospital, Jena, Germany.
Langenbecks Arch Surg. 2021 Jun;406(4):1111-1118. doi: 10.1007/s00423-021-02181-1. Epub 2021 May 10.
Here, we analyse the technical modification of the ALPPS procedure, ligating the middle hepatic vein during the first step of the operation to enhance remnant liver hypertrophy.
In 20 of 37 ALPPS procedures, the middle hepatic vein was ligated during the first step. Hypertrophy of the functional remnant liver volume was assessed in addition to postoperative courses.
Volumetric analysis showed a significant volume increase, especially for patients with colorectal metastases. Pre-existing liver parenchyma damage (odds ratio = 0.717, p = 0.017) and preoperative chemotherapy were found to be significant predictors (odds ratio = 0.803, p = 0.045) of higher morbidity and mortality. In addition, a survival benefit for maintenance of middle hepatic vein was shown.
This technical modification of the ALPPS procedure can accentuate future liver remnant volume hypertrophy. The higher morbidity and mortality observed are most likely associated with pre-existing parenchymal damage within this group.
在此，我们分析了联合肝脏离断和门静脉结扎的二步肝切除术（ALPPS）的技术改良，即在手术的第一步中结扎肝中静脉以增强剩余肝脏的代偿性增生。
在 37 例 ALPPS 手术中，有 20 例在第一步中结扎了肝中静脉。除了术后过程外，还评估了功能性剩余肝脏体积的代偿性增生。
体积分析显示出显著的体积增加，特别是对于结直肠转移的患者。术前存在的肝实质损伤（比值比=0.717，p=0.017）和术前化疗是更高发病率和死亡率的显著预测因素（比值比=0.803，p=0.045）。此外，还显示出保留肝中静脉有生存获益。
ALPPS 手术的这种技术改良可以增强未来剩余肝脏体积的代偿性增生。在这组患者中观察到的更高发病率和死亡率很可能与术前存在的实质损伤有关。
