Chirurgia (Bucur). 2021 Aug;116(4):409-423. doi: 10.21614/chirurgia.116.4.409.
Presentation of the first experience of a liver surgery center in applying an innovative procedure - ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) for massive liver tumors. This medod has been performed in the surgery clinic 2 since 2018 in patients with massive primary or metastatic liver tumors, whose future residual liver volume is considered too small to perform curative liver resection safely. Until recently, these conditions assigned large tumors occupying more than 75-90% of the liver to the group of unresectable tumors. Prospectively, the ALPPS procedure was evaluated to convert unresectable liver tumors due to the small residual liver volume into resectable ones. Literature data were systematically reviewed using PubMed, Scopus, Google Scholar. Materials and methods: Since June 2018, 18 ALPPS procedures were performed in patients aged 62 +-8 years. Indications for surgical resection were liver metastases of colorectal cancer in 7 cases, perihilar cholangiocarcinoma in 4 cases, hepatocellular carcinoma in 6 cases, and GIST metastases 1 case. From the literature data we analyzed articles from 2014 to 2019. Residual liver volume was calculated on CT angiography using the program included in the Siemens machine software and was 252 +- 115 ml (19.4 +- 6.2%) before ALPPS-1 and 542 +- 165 ml (30.7 +- 6.5%) before ALLPS-2 (P 0.001). The increase in residual liver volume between the two procedures was 60.4 +- 38% (range: 31-110%, P 0.001). The mean time between the first and second procedure was 9.4 +- 2.3 days. Average hospital stay was 28.4 +- 9.2 days. Postoperative morbidity 34.8%, mortality 0. Survival at 18 months was 100%. Conclusion: The ALPPS technique allows us to increase the resectability rate in patients with initially unresectable liver tumors with favorable postoperative outcomes. Careful selection of patients for a major complex procedure such as ALPPS allowed us to avoid postoperative mortality. Liver cirrhosis, cholestasis, and intraoperative hemorrhage are major factors for the development of postoperative morbidity.
呈现肝脏外科中心在应用创新手术方法（联合肝脏离断和门静脉结扎的分阶段肝切除术，ALPPS）治疗巨大肝脏肿瘤方面的首次经验。自 2018 年以来，该方法已在第二外科手术科室中对患有巨大原发性或转移性肝脏肿瘤的患者进行，这些患者的未来残余肝体积被认为太小，无法安全地进行治愈性肝切除术。直到最近，这些条件将占据肝脏 75-90%以上的大肿瘤归入无法切除的肿瘤组。前瞻性地，ALPPS 手术被评估为将由于残余肝体积小而无法切除的肝脏肿瘤转化为可切除的肿瘤。使用 PubMed、Scopus、Google Scholar 系统地回顾了文献数据。材料和方法：自 2018 年 6 月以来，对 18 例年龄为 62+/-8 岁的患者进行了 18 例 ALPPS 手术。手术切除的适应证为结直肠癌肝转移 7 例，肝门部胆管癌 4 例，肝细胞癌 6 例，GIST 转移 1 例。从文献数据中，我们分析了 2014 年至 2019 年的文章。残余肝体积通过西门子机器软件中包含的程序在 CT 血管造影上计算，ALPPS-1 前为 252+/-115ml（19.4+/-6.2%），ALPPS-2 前为 542+/-165ml（30.7+/-6.5%）（P<0.001）。两例之间残余肝体积的增加为 60.4+/-38%（范围：31-110%，P<0.001）。第一次和第二次手术之间的平均时间为 9.4+/-2.3 天。平均住院时间为 28.4+/-9.2 天。术后发病率为 34.8%，死亡率为 0。18 个月的生存率为 100%。结论：ALPPS 技术使我们能够提高初始不可切除的肝脏肿瘤患者的可切除率，并获得良好的术后结果。对 ALPPS 等主要复杂手术的患者进行仔细选择，使我们能够避免术后死亡。肝硬化、胆汁淤积和术中出血是术后发病率发展的主要因素。
