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 wit...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 insufficient 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 identified by searching MED- LINE 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＂ Addi- tional papers were identified 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 benefits of ALPPS include rapid hypertrophy 47%-110% of the liver over a median of 6-16.4 days, and 95%-100% com- pletion 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 prelimina展开更多
目的:探讨显微镜下精索静脉结扎术对精索静脉曲张患者的治疗效果。方法:选择2011年9月至2015年2月来我院进行治疗的精索静脉曲张患者120例,随机分为试验组和对照组,各60例。试验组行显微镜下精索静脉结扎术,对照组患者行传统开放高位结...目的:探讨显微镜下精索静脉结扎术对精索静脉曲张患者的治疗效果。方法:选择2011年9月至2015年2月来我院进行治疗的精索静脉曲张患者120例,随机分为试验组和对照组,各60例。试验组行显微镜下精索静脉结扎术,对照组患者行传统开放高位结扎术。对比手术前后两组患者平静呼吸和作Valsalva动作后精索静脉内径、精索静脉返流时间、睾丸包膜动脉血流数值和精液质量。结果:组间比较显示,术后3个月试验组患者精索静脉返流时间显著短于对照组患者[(0.41±0.1)s vs(1.08±0.1)s,P<0.05],术后3个月试验组患者精索静脉最大内径在静息、Valsalva动作状态下均超过对照组[(1.63±0.07)mm vs(1.59±0.06)mm,(1.72±0.05)mm vs(1.68±0.07)mm,P均<0.05];术后3个月试验组患者睾丸包膜动脉收缩期最大流速(PSV)(9.26±1.35 vs 10.64±1.28,P<0.05)、血管阻力指数(RI)(0.52±0.03 vs 0.61±0.03,P<0.05)均较对照组明显减少;术后3个月试验组患者精子浓度[(46.84±5.24)×106/ml vs(35.35±4.26)×106/ml,P<0.05]、精子活率[(63.75±7.73)%vs(53.87±6.46)%,P<0.05]及总精子计数[(89.54±7.95)×106/ml vs(75.24±8.43)×106/ml,P<0.05)]均高于对照组。结论:本研究结果显示,显微镜下精索静脉结扎术疗效确切,可以有效改善睾丸血流,提高精液质量,值得临床推广。展开更多
文摘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 insufficient 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 identified by searching MED- LINE 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＂ Addi- tional papers were identified 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 benefits of ALPPS include rapid hypertrophy 47%-110% of the liver over a median of 6-16.4 days, and 95%-100% com- pletion 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 prelimina
文摘目的:探讨显微镜下精索静脉结扎术对精索静脉曲张患者的治疗效果。方法:选择2011年9月至2015年2月来我院进行治疗的精索静脉曲张患者120例,随机分为试验组和对照组,各60例。试验组行显微镜下精索静脉结扎术,对照组患者行传统开放高位结扎术。对比手术前后两组患者平静呼吸和作Valsalva动作后精索静脉内径、精索静脉返流时间、睾丸包膜动脉血流数值和精液质量。结果:组间比较显示,术后3个月试验组患者精索静脉返流时间显著短于对照组患者[(0.41±0.1)s vs(1.08±0.1)s,P<0.05],术后3个月试验组患者精索静脉最大内径在静息、Valsalva动作状态下均超过对照组[(1.63±0.07)mm vs(1.59±0.06)mm,(1.72±0.05)mm vs(1.68±0.07)mm,P均<0.05];术后3个月试验组患者睾丸包膜动脉收缩期最大流速(PSV)(9.26±1.35 vs 10.64±1.28,P<0.05)、血管阻力指数(RI)(0.52±0.03 vs 0.61±0.03,P<0.05)均较对照组明显减少;术后3个月试验组患者精子浓度[(46.84±5.24)×106/ml vs(35.35±4.26)×106/ml,P<0.05]、精子活率[(63.75±7.73)%vs(53.87±6.46)%,P<0.05]及总精子计数[(89.54±7.95)×106/ml vs(75.24±8.43)×106/ml,P<0.05)]均高于对照组。结论:本研究结果显示,显微镜下精索静脉结扎术疗效确切,可以有效改善睾丸血流,提高精液质量,值得临床推广。
