肝脏外科的新挑战:联合肝脏分隔和门静脉结扎的二步肝切除术

摘要

An innovative approach,named associating liver partition and portal vein ligation for staged hepatectomy (ALPPS),has made possible a marked increase in future liver remnant (FLR) over a short period of time,and has challenged the concept of unresectability.To date,ALPPS has been employed for a variety of primary and metastatic liver tumors from many centers across the world.Many technical variations of ALPPS have been described.However,much controversy has surrounded this procedure,and many problems remain to be solved,such as the reasons for rapid hypertrophy,the technical feasibility,safety and long-term oncologic outcomes,and the result compared with the conventional two-stage hepatectomy.These aspects are needed to be evaluated further in large-scale studies.We believe that the ALPPS procedure will has much room for further development.%联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)作为一全新的手术方式,为既往因剩余肝脏体积不足,无法行根治性手术切除的肝癌患者带来了希望.目前,ALPPS已在全世界多个中心开展,许多技术的改良亦见报道.然而,关于ALPPS的诸多争议及疑问,如剩余肝脏体积快速增长的原因、手术安全性及远期预后的担忧,以及与传统手术方式比较的优劣等仍无法做出准确而令人信服的回答.目前全世界范围的多中心协作及临床随机对照研究是关键.笔者相信ALPPS仍有进一步发展的空间.