Lau WY, Lai ECH, Lau SHY. Associating liver partition and portal vein ligation for staged hepatectomy: the current role and development. Hepatobiliary Pancreat Dis Int 2017; 16(1): 17-26. DOI:10.1016/S1499-3872(16)60174-1
劉允怡院士
中國科學院院士，國際著名肝膽胰外科專家，香港中文大學外科學系教授，香港和東南亞地區肝移植創始人之一。1972年畢業於香港大學醫學院，1995年獲香港中文大學醫學博士學位。
聯合肝臟離斷和門靜脈結紮的二步肝切除術（ALPPS）於2007年開始，被用於誘導快速肝臟肥大和減少肝切除後肝衰竭的發生。ALPPS仍被認為處於發展的早期階段，因為目前手術適應症和技術尚未標準化。來自香港中文大學的劉允怡院士團隊在我刊2017年第一期刊登重磅綜述，總結回顧了ALPPS在當前臨床中的應用和未來發展。
通過對2007年1月至2016年10月MEDLINE和PubMed的檢索總結，ALPPS的優勢在於能更快的誘導肝臟肥大，同時ALPPS的第二階段也有95%-100%的完成率。但ALPPS的主要缺點集中於其高併發症率和高死亡率。同時，快速的肝臟肥大是否會加速腫瘤的快速進展和傳播，目前尚不清楚。
因此，由於目前對ALPPS的了解有限，並且缺乏前瞻性隨機對照研究。從初步結果來看，ALPPS的安全仍然存在問題，僅建議具有豐富經驗的大型肝膽外科中心開展ALPPS。
【Abstract】
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been developed to induce rapid liver hypertrophy and reduce posthepatectomy liver failure in patients with insuffcient future liver remnant (FLR). ALPPS is still considered to be in an early developmental phase because surgical indications and techniques have not been standardized. This article aimed to review the current role and future developments of ALPPS.
DATA SOURCES: Studies were identifed by searching MEDLINE and PubMed for articles from January 2007 to October 2016 using the keywords 「associating liver partition and portal vein ligation for staged hepatectomy」 and 「ALPPS」. Additional papers were identifed by a manual search of references from key articles.
RESULTS: ALPPS induces more hypertrophy of the FLR in less time than portal vein embolization or portal vein ligation. The benefts of ALPPS include rapid hypertrophy 47%-110% of the liver over a median of 6-16.4 days, and 95%-100% completion rate of the second stage of ALPPS. The main criticisms of ALPPS are centered on its high morbidity and mortality rates. Morbidity rates after ALPPS have been reported to be 15.3%-100%, with ≥ the Clavien-Dindo grade III morbidity of 13.6%-44%. Mortality rates have been reported to be 0%-29%. The important questions to ask even if oncologic long-term results are acceptable are: whether the gain in quality and quantity of life can be off balance by the substantial risks of morbidity and mortality, and whether stimulation of rapid liver hypertrophy also accelerates rapid tumor progression and spread. Up till now, the documentations of the ALPPS procedure come mainly from case series, and most of these series include heterogeneous groups of malignancies. The numbers are also too small to separately evaluate survival for different tumor etiologies.
CONCLUSIONS: Currently, knowledge on ALPPS is limited, and prospective randomized studies are lacking. From the reported preliminary results, safety of the ALPPS procedure remains questionable. ALPPS should only be used in experienced, high-volume hepatobiliary centers.
聯繫電話
+86-571-87236559，+86-571-87236600
在線投稿
https://mc03.manuscriptcentral.com/hbpdint
優先出版
http://www.hbpdint.com/EN/article/showNewArticle.do
hbpdint@126.com，hbpdje@zju.edu.cn
Website
www.hbpdint.com