Desarrollo de un modelo experimental de ligadura portal asociada a transección parenquimatosa (ALPPS) en ratas

BackgroundLiver failure migth be a cause of death after major hepatectomies. The ALPPS technique appears to be a promising strategy to avoid it, however no experimental studies supporting this procedure have been previously described. The aim was to develop an experimental model of ALPPS in rats.MethodExperimental. A total of 30 Sprague Dawley rats were used. To develop the ALPPS procedure, ligation of the left portal branch of the middle lobe (LM) was performed. This demarcates the left side (SILM) from the right side (SDLM); parenchyma transection was performed following the demarcated line. The animal's weight, volume and weight of both LM were analyzed. Sacrifice at 3, 7 and 14 days after the procedure (10 per group) was performed.ResultsNo bleeding or ascites were observed during the postoperative period. The LM increased by 24.1, 86.9 and 120.4% at 3, 7 and 14 days. The SDLM increased by 34.4, 78.8 and 102.0% at 3, 7 and 14 days. The SILM decreased 42.6, 64.8, and 79.3% at day 3, 7 and 14 days respectively.ConclusionThe ALPPS procedure can be performed in rats, achieving the expected results. Comparison studies to 2 staged hepatectomy will be necessary.     

肝静脉剥夺术——残余肝脏不足时手术新思路

肝静脉剥夺术（liver venous deprivation,LVD）是近年来两步法肝切除最新开展的手术方式,以联合应用门静脉栓塞（portal vein embolization,PVE）和肝静脉栓塞（hepatic vein embolization,HVE）的方式来达到使残余肝脏（future liver remnant,FLR）快速增生的目的。LVD相比于之前开展的单纯PVE和联合肝脏分隔和门静脉结扎二步肝切除术（associating liver partition and portal vein ligation for staged hepatectomy,ALPPS）,在达到了FLR迅速增生的同时,对病人造成更小的损伤,其并发症发生率和病死率也远远低于ALPPS。这也使得更多的肝脏恶性肿瘤病人获得了R0切除的机会。     

Resección en 2 tiempos de tumores hepáticos perihiliares con torniquete en la cisura umbilical y embolización portal secuencial al cuarto día postoperatorio (ALTPS modificado)

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) achieves the hypertrophy of the future liver remnant in seven days. We achieved the same hypertrophy placing a tourniquet in the parenchimal transection line associating a right portal vein ligation (associating liver tourniquet and right portal vein ligation for staged hepatectomy-ALTPS). In perihiliar tumors a«non touch» technique should be performed. ALPPS y ALTPS do not comply with this technical aspect because a dissection of the hilum is carried out in both procedures during the portal dissection. To avoid this problem we devised a new method called sequential ALTPS. It consists of placing a tourniquet in the umbilical fissure without ligation of the right portal vein during the first stage. Subsequently, on the 4^th postoperative day we perform a percutaneous right portal vein embolization. We present the first case of this new technique in which we have obtained a hypertrophy of 77% of the future liver remnant seven days after portal vein embolization. In the second stage a right trisectionectomy was performed with inferior vena cava resection with a goretex graft replacement.     

Salvage transhepatic arterial embolization after failed stage I ALPPS in a patient with a huge HCC with chronic liver disease: A case report

IntroductionThe degree of hypertrophy of the future liver remnant (FLR) induced by associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with HCC and chronic liver disease is often limited as compared with patients with a healthy liver.Presentation of caseWe reported a 53-year-old male who had a huge HCC (14.8 × 12 × 9.4 cm) arising from a background of hepatitis B liver fibrosis (METAVIR score F3). The ratio of the FLR/standard liver volume (SLV) was 23.8%. After stage I ALPPS, volumetric assessment on postoperative day (POD) 7 and 13 showed insufficient FLR hypertrophy (FLR/SLV: 28.7% and 30.7%, respectively). A postoperative computed tomographic 3D reconstruction and hepatic angiography showed steal of arterial blood from the FLR to the huge tumour in the right liver. Salvage transhepatic arterial embolization (TAE) was performed to block the major arterial blood supply to the tumour on POD 13. The FLR/SLV increased to 42.5% in 7 days. Stage II ALPPS consisting of right trisectionectomy was successfully performed.DiscussionSalvage TAE which blocked the main arterial blood supply to the huge HCC improved the arterial supply with subsequent adequate and fast hypertrophy of the FLR to allow trisectionectomy in stage II ALPPS to be carried out.ConclusionSalvage TAE after failed stage I ALPPS with inadequate hypertrophy of the FLR allowed trisectionectomy in stage II ALPPS to be carried out in a patient with a huge HCC with chronic liver disease.     

Ablative Liver Partition and Portal Vein Embolization: Proof-of-Concept Testing in a Rabbit Model

Purpose

To test the hypothesis that a modified approach to portal vein embolization (PVE)—termed ablative liver partition (ALP) and PVE (ALP-PVE)—is feasible and results in greater future liver remnant (FLR) growth compared with PVE alone in a rabbit model.

联合肝脏分隔和门静脉结扎的二步肝切除术在结直肠癌肝转移治疗中的价值和评价

联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）作为一种全新的手术方式,为许多剩余肝脏体积不足,采用其他方法无法切除的巨大肝癌或多发性肝癌病人提供了治愈性切除的机会,显示出确切疗效和广阔应用前景,引起了国际肝胆外科领域的广泛关注。尽管ALPPS的适应证不断拓展,但其最佳适应证仍为结直肠癌肝转移。通过严格把握手术指征,不断改进技术,尤其是腹腔镜、手术机器人及射频等微创技术的应用,ALPPS的围手术期并发症发生率和病死率已显著降低。现有的研究结果显示,ALPPS应用于结直肠癌肝转移的治疗安全、可行,可获得良好的远期肿瘤学结果,但尚需大样本、前瞻性随机对照研究进一步证实。目前,亟需进一步规范、完善ALPPS系列技术方法,总结技术要点和并发症防治措施,明确其适应证和禁忌证,并制定实施规范。     

按照损伤控制原则改进ALPPS手术的可行性及效果

目的 探讨通过损伤控制原则对联合肝脏离断和门静脉结扎的分期肝脏切除术(ALPPS)手术方式进行改进,并系统评价该手术方式的有效性和安全性.方法 回顾性分析近5年来空军军医大学附属空军特色医学中心与淄博市中心医院联合开展的ALPPS手术治疗患者65例.损伤控制策略包括病例纳入标准的修订、精确的剩余肝脏体积评估和手术规划、...