联合肝脏分隔和门静脉结扎的二步肝切除术临床与基础研究进展

联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）由德国Hans Schlitt教授在2007年首创，即通过Ⅰ期手术时结扎肝脏荷瘤侧肝叶的门静脉分支，同时分隔荷瘤侧和健侧肝组织，使健侧肝脏在1~2周内快速再生，待健侧肝脏增生足够时，Ⅱ期手术切除荷瘤侧肝脏，可使相当一部分原本不能手术切除的肝癌患者重新获得根治性切除的机会。ALPPS效果显著，相对于门静脉栓塞可更快速地诱导肝脏再生，并且随着手术经验的积累和外科技术的改良，ALPPS术后并发症率明显降低，越来越多地应用于原发性和继发性肝脏肿瘤的治疗，包括结直肠癌肝转移、肝细胞癌和肝内胆管癌等。ALPPS自创立以来，其临床改良术式不断涌现，包括基本手术技术和技巧的改进、肝脏分隔的微创改进、门静脉结扎的微创改进、手术入路的微创改进和经导管动脉栓塞术补救性ALPPS等。ALPPS诱导肝再生过程中肝脏免疫微环境可发生明显的变化，但关键免疫组分的作用、肝再生的空间起源、分布及其亚群特征等仍有待明确。目前，ALPPS对肝脏肿瘤的具体影响及其机制并不完善，仍需进一步探索和证实。ALPPS的临床应用前景广阔，相关机制研究的转化也有望为临床主动诱导肝再生和肝功能衰竭的防治提供新的思路。

Advances in clinical and basic research of associating liver partition and portal vein ligation for staged hepatectomy

The Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), first developed by Professor Hans Schlitt from Germany in 2007, combines the ligation of the portal vein branches of the tumor-bearing lobe and separation of the tumor-bearing lobe from the healthy lobe at the same time during the first stage, allows for rapid regeneration of the healthy lobe within 1-2 weeks. Once the healthy liver lobe has grown sufficiently, the tumor-bearing lobe is removed in the second stage of operation, which provides an opportunity for radical resection for a significant portion of patients with liver cancer initially considered unresectable. ALPPS has remarkable efficacy inducing more rapid liver regeneration than traditional portal vein embolization. Furthermore, with the accumulation of surgical experience and refinements in surgical techniques, the postoperative complication rate of ALPPS has significantly decreased. As a result, it is increasingly being applied in the treatment of primary and secondary liver tumors, including colorectal liver metastases, hepatocellular carcinoma, and intrahepatic cholangiocarcinoma. Since its inception, ALPPS has undergone continuous clinical modifications, such as advancements in basic surgical techniques and skills, minimally invasive hepatic partition, minimally invasive portal vein ligation, minimally invasive surgical approaches, and rescue ALPPS using transcatheter arterial embolization. During the liver regeneration induced by ALPPS, significant changes can occur in the hepatic immune microenvironment. However, the roles of key immune components, spatial origin, distribution, and subpopulation characteristics during liver regeneration remain to be clarified. The specific effects and mechanisms of ALPPS on liver tumors are not fully understood and require further exploration and confirmation. The clinical application prospects of ALPPS are promising, and research on related mechanisms may offer new insights into the active induction of liver regeneration and the prevention and treatment of liver function failure.