联合肝脏分隔和门静脉结扎二步肝切除术治疗传统不可切除肝癌之进展

近年来,肝癌综合治疗进展显著,但手术切除仍为肝癌病人获得长期生存的主要治疗方式。随着肝脏外科的快速发展,肝脏解剖学的复杂性和手术操作已不再是肝脏手术的主要障碍,肝切除术后剩余肝脏体积不足成为肝脏手术的主要限制因素。临床上多数肝癌病人因此无法行一期根治性切除术,只能接受非手术治疗,长期预后较差。联合肝脏分隔和门静脉结扎二步肝切除术(ALPPS)为剩余肝脏体积不足的肝癌病人治疗带来希望。ALPPS可在短期内诱导剩余肝脏显著增生,肿瘤根治切除率高达90%~100%,显著改善病人生存。但在开展早期,其手术安全性等争议不断。近年来,随着技术的不断进步,ALPPS手术安全性等问题得到较大改善。笔者综合国内外最新文献,围绕ALPPS的最新进展进行深入阐述。

Advances of associating liver partition and portal vein ligation for staged hepatectomy in the treatment of primarilly unresectable liver cancer

In recent years,the systematic treatment of liver cancer has made significant progress,but surgical resection remains as main treatment to obtain long-term survival for patients with liver cancer.With the rapid development of liver surgery,the complexity of liver anatomy and surgical operation are no longer the main obstacles to liver surgery.The insufficient future liver remnant(FLR)after hepatectomy has become the main limit of liver surgery.In clinical practice,most patients with liver cancer cannot undergo one-stage radical resection and can only receive non-surgical treatment,with poor long-term prognosis.The associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)provides hope for the treatment of liver cancer patients with insufficient FLR.ALPPS can induce significant hypotrophy of the FLR in a short period of time,and the radical tumor resection rate is as high as 90%to 100%,which significantly improves the prognosis of patients.However,in the early stages of the practice,there were considerable controversies on the safety of the operation.In recent years,with the continuous advancement of technology,the safety of ALPPS has been greatly improved.The authors synthesize the latest literatures and elaborate on the latest progress of ALPPS.