联合肝脏离断和门静脉结扎的二步肝切除术在不可切除肝细胞癌中的应用

对于残余肝体积不足的肝细胞癌患者,联合肝脏离断合并门静脉结扎的二步肝切除术(ALPPS)可以达到快速增大残余肝体积并切除肿瘤的目的,但仍有其弊端和未知性存在。ALPPS作为肝胆领域的新技术,在问世的10余年来,其适用范围在扩展,技术得到进一步改良。概述国内外对肝细胞癌患者施行ALPPS的经验,分析ALPPS在肝细胞癌患者应用中的关键问题,探讨其在靶向治疗和免疫治疗盛行时代中的机遇和挑战。

Application of associating liver partition and portal vein ligation for staged hepatectomy in unresectable hepatocellular carcinoma

For hepatocellular carcinoma patients with insufficient residual liver volume,associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)can achieve the goal of rapidly increasing residual liver volume and removing the tumor,but there are still drawbacks and uncertainties.As a new technique in the field of hepatobiliary surgery,the range of application of ALPPS has been expanded and its technique has been further improved in the past 10 years since its inception.This article summarizes the experience in implementing ALPPS in patients with hepatocellular carcinoma in China and globally,analyzes the key issues of the application of ALPPS in hepatocellular carcinoma patients,and discusses its opportunities and challenges in the era of targeted therapy and immunotherapy.