摘要
肝切除术目前仍是肝癌患者获得长期存活的主要手段,但是对于一些肿瘤体积较大或位置特殊的病例,术前评估发现手术切除病灶后剩余肝脏体积过小,不能满足基本生理功能,而且术后肝衰竭的风险极高,因此患者失去手术机会。随着联合肝脏分隔和门静脉结扎的分步肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)在肝脏外科领域的广泛应用和发展,使得此类患者的手术切除成为可能。手术过程分为两步,第一步对拟切除肝脏组织侧的门静脉分支进行结扎,并离断该部分肝实质;术后一定时间内评估剩余肝脏组织增生情况,符合标准后行第二步彻底切除肿瘤的手术。近年来,随着腹腔镜技术在肝胆外科的广泛应用和日益成熟,ALPPS手术也开始逐步进入微创时代。虽然国内外关于腹腔镜ALPPS的文献报道越来越多,但仍缺少系统的研究来评价其安全性、可行性及有效性。文章旨在通过检索国内外关于腹腔镜ALPPS手术的相关文献资料进行探讨,对腹腔镜与开腹ALPPS治疗原发性及转移性肝癌的临床应用效果进行系统综述。
Hepatectomy is still the main treatment for patients with liver cancer to obtain long-term survival.However,for some patients with large tumor size or special location,the preoperative evaluation shows that the residual liver volume after resection is too small to meet the basic physiological function,and the risk of postoperative liver failure is very high,so these patients lost the opportunity for surgery.With the extensive application and development of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)in the field of liver surgery,surgical resection becomes possible for these patients.The operation process is divided into two steps.The first step is to ligate the branch of the portal vein on the side of the liver tissue to be removed and disconnect the part of the liver parenchyma.The remaining liver tissue hyperplasia is evaluated within a certain period after operation,and the second step of complete tumor resection is performed after meeting the criteria.In recent years,with the wide application and growing maturity of laparoscopic technology in hepatobiliary surgery,ALPPS surgery has gradually entered the era of minimally invasive surgery.Although there are more and more reports about laparoscopic ALPPS at home and abroad,there is still a lack of systematic research to evaluate its safety,feasibility and effectiveness.The purpose of this article is to systematically review the clinical effects of laparoscopic and laparotomy ALPPS in the treatment of primary and metastatic liver cancer by searching the relevant literature.
作者
曹际森
张晔
CAO Jisen ZHANG Ye(Department of Hepatobiliary Surgery,the Third Central Hospital of Tianjin,Tianjin 300170,China)
出处
《继续医学教育》
2023年第2期164-168,共5页
Continuing Medical Education
关键词
ALPPS
腹腔镜
原发性肝癌
转移性肝癌
临床效果
系统综述
ALPPS
laparoscope
primary liver cancer
metastatic liver cancer
clinical efficacy
systematic review
