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第42卷第6期 南京医科大学学报(自然科学版)
2022年6月 Journal of Nanjing Medical University(Natural Sciences) ·891 ·
·综 述·
联合肝脏离断和门静脉结扎二步肝切除术的应用进展
陈一帆,黄 博,卢杏生 *
南京医科大学附属苏州医院肝胆外科,江苏 苏州 215002
[摘 要] 肝脏肿瘤早期诊断率低,大部分患者初诊即失去手术机会。剩余肝脏体积(future liver remnant,FLR)不足是无法
手术的主要原因,这已成为制约肝脏外科发展的瓶颈。联合肝脏离断和门静脉结扎二步肝切除术(associating liver partition
and portal vein ligation for staged hepatectomy,ALPPS)能够促进剩余肝脏快速增生,进而接受手术切除,显著改善了无法手术患
者的预后。但这项技术开展之初,因其安全性问题争议较大,现已得到明显改善。文章通过总结ALPPS相关文献来阐述其临
床应用方面的进展。
[关键词] 肝脏肿瘤;联合肝脏离断和门静脉结扎二步肝切除术;剩余肝脏体积;肝切除术;切除后肝功能衰竭
[中图分类号] R657.3 [文献标志码] A [文章编号] 1007⁃4368(2022)06⁃891⁃06
doi:10.7655/NYDXBNS20220621
Progress in the application of associating liver partition and portal vein ligation for staged
hepatectomy
CHEN Yifan,HUANG Bo,LU Xingsheng *
Department of Hepatobiliary Surgery,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,
China
[Abstract] The early diagnostic rate of liver cancer is low. Most patients lose the opportunity for surgical resection when they are
first diagnosed. It is not eligible for patients to achieve operations mainly due to deficient future liver remnant(FLR)which obstacles
the development of liver surgery. Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)enables patients
undergo radical excision by rapid liver hypertrophy,which significantly improves the prognosis of patients. Now ALPPS has
substantially gained improvement,which was remarkably controversial for its safety issue in the early stage of practice. This review will
elaborate the progress of clinical applications by synthesizing the articles concerning ALPPS.
[Key words] liver cancer;associating liver partition and portal vein ligation for staged hepatectomy;future liver remnant;liver resec⁃
tion;post⁃hepatectomy liver failure
[J Nanjing Med Univ,2022,42(06):891⁃896]
尽管近年来免疫及靶向药物在肝胆肿瘤领域 肝脏增生成为肝脏外科医师最为关注的问题。联
取得了较大进展,使许多中晚期患者成功实现转化 合肝脏离断和门静脉结扎二步肝切除术(associat⁃
治疗,但可行手术者仅占 15%~30% ,根治性切除 ing liver partition and portal vein ligation for staged
[1]
仍是实现长期生存的重要手段 。无法手术的主要 hepatectomy,ALPPS)可使FLR在短时间内迅速增长
[2]
原因是剩余肝脏体积(future liver remnant,FLR)不 以满足手术要求,进而提高肿瘤切除率,改善患者
足,这部分患者生存期短,预后极差。如何使剩余 预后。但在开展之初,较高的并发症发生率及早期
病死率使 ALPPS 在手术安全性方面受到了极大质
疑 。由于技术的不断改良,临床应用逐渐增多,其
[3]
[基金项目] 苏州市医学重点学科项目(SZXK201808)
并发症率及病死率已较前明显下降 ,ALPPS 也在
[4]
∗
通信作者(Corresponding author),E⁃mail:luxingsheng88@sina.
com 慢慢走向成熟。