摘要
目的评价联合肝脏离断和门静脉结扎二步肝切除术（ALPPS）改良术式可行性、安全性及有效性。方法系统检索Embase、Pubmed、Medline、Google Scholar数据库中有关ALPPS改良术式的文献，根据纳入与排除标准对文献进行筛选，提取相应指标进行描述性分析。结果分析共纳入5篇符合标准的文献。62例患者分别接受了5种ALPPS改良术式：单个肝段ALPPS、前入路ALPPS、部分ALPPS（p-ALPPS）、射频辅助肝脏离断与门静脉结扎术（RALPP）以及联合肝脏止血带绕扎与门静脉结扎术（ALTPS），其中50例（80．6％）为结直肠癌肝转移患者。ALPPS改良术式二步手术间隔时间平均为8～22d，剩余肝脏体积（FLR）增生率为48．7％～62．3％，其可行性达98．4％。术后严重并发症发生率为11．8％～33．3％。单个肝段ALPPS、p-ALPPS、RALPP改良术式90天病死率为0，而ALTPS则为8．3％。住院期间病死率前入路ALPPS及ALTPS分别为5．9％和8．3％，其余3种改良术式均为0。仅单个肝段ALPPS及ALTPS改良术式报道了肿瘤学效应，两者R0切除率、总生存率、无病生存率及复发率分别为83．3％、80％、50％、50％和100％、100％、95％、5％。结论ALPPS改良术式具有一定的可行性，且提高了安全性，但其有效性仍需要进一步研究。
Objective To evaluate the feasibility, safety and effectiveness of modified associating liver partition and portal vein ligation for staged hepatectomy （ALPPS）. Methods The published litera- tures associated with modified ALPPS were pooled from Embase, Pubmed, Medline, Google Scholar databas- es. The studies were included or excluded depends on our predetermined criteria. We selected data and per- formd descriptive analysis from the included studies. Results Five articles were included and reviewed. A total of 62 patients underwent five modified procedures, including monosegment ALPPS （m-ALPPS） , anteri- or approach ALPPS, partial-ALPPS, radiofrequency-assisted liver partition with portal vein ligation （RALPP） and associating liver tourniquet and portal ligation for staged hepatectomy （ALTPS）. There were 50 （ 80. 6% ） patients diagnosed liver metastatic colorectal cancer. The average operation interval of modified ALPPS was between 8 -22 days and growth rate of future liver remnant （FLR） ranged from 48.7% to 62. 3%, the feasibility to perform ALPPS stage 2 was 98.4%. The incidence of severe postoperative compli- cations were between ll. 8% -33.3%. The 90-day mortality for monosegment ALPPS, partial-ALPPS and RALPP was 0, while the figure was 8.3% in ALTPS. The in-hospital morbidities were 5.9% and 8.3% for anterior approach ALPPS and ALTPS, respectively, which were 0 in the other three modified groups. Clini- cal response evaluation, including R0 resection rate, overall survival rate, disease-free and recurrence rates were merely presented 83.3% , 80% , 50% , 50% in m-ALPPS group, while 100% , 100% , 95% , 5% in modified ALTPS group. Conclusion Modified ALPPS with improved safety is feasible in clinical practice. However, the effectiveness still needs further studies.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2016年第9期597-601,共5页
Chinese Journal of Hepatobiliary Surgery
基金
湖南省卫生计生委科研基金（C2016082）
南华大学研究生创新基金（2015XCX43）
关键词
肝肿瘤
联合肝脏离断和门静脉结扎二步肝切除术
改良术式
残余肝
Liver neoplasm
Associating liver partition and portal vein ligation for staged hepa-tectomy
Modified procedure
Future liver remnant
