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联合肝脏离断和门静脉结扎二步肝切除术改良术式的系统评价

Modified associating liver partition and portal vein ligation for staged hepatectomy: a systematic review

摘要:

目的 评价联合肝脏离断和门静脉结扎二步肝切除术(A LPPS)改良术式可行性、安全性及有效性.方法 系统检索Embase、Pubmed、Medline、Google Scholar数据库中有关ALPPS改良术式的文献,根据纳入与排除标准对文献进行筛选,提取相应指标进行描述性分析.结果 分析共纳入5篇符合标准的文献.62例患者分别接受了5种ALPPS改良术式:单个肝段ALPPS、前入路ALPPS、部分ALPPS (p-ALPPS)、射频辅助肝脏离断与门静脉结扎术(RALPP)以及联合肝脏止血带绕扎与门静脉结扎术(ALTPS),其中50例(80.6%)为结直肠癌肝转移患者.ALPPS改良术式二步手术间隔时间平均为8 ~22 d,剩余肝脏体积(FLR)增生率为48.7% ~ 62.3%,其可行性达98.4%.术后严重并发症发生率为11.8% ~33.3%.单个肝段ALPPS、p-ALPPS、RALPP改良术式90天病死率为0,而ALTPS则为8.3%.住院期间病死率前入路ALPPS及ALTPS分别为5.9%和8.3%,其余3种改良术式均为0.仅单个肝段ALPPS及ALTPS改良术式报道了肿瘤学效应,两者R0切除率、总生存率、无病生存率及复发率分别为83.3%、80%、50%、50%和100%、100%、95%、5%.结论 ALPPS改良术式具有一定的可行性,且提高了安全性,但其有效性仍需要进一步研究.

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abstracts:

Objective To evaluate the feasibility,safety and effectiveness of modified associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).Methods The published literatures associated with modified ALPPS were pooled from Embase,Pubmed,Medline,Google Scholar databases.The studies were included or excluded depends on our predetermined criteria.We selected data and performd descriptive analysis from the included studies.Results Five articles were included and reviewed.A total of 62 patients underwent five modified procedures,including monosegment ALPPS (m-ALPPS),anterior approach ALPPS,partial-ALPPS,radiofrequency-assisted liver partition with portal vein ligation (RALPP) and associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS).There were 50 (80.6%) patients diagnosed liver metastatic colorectal cancer.The average operation interval of modified ALPPS was between 8 ~ 22 days and growth rate of future liver remnant (FLR) ranged from 48.7% to 62.3%,the feasibility to perform ALPPS stage 2 was 98.4%.The incidence of severe postoperative complications were between 11.8% ~33.3%.The 90-day mortality for monosegment ALPPS,partial-ALPPS and RALPP was 0,while the figure was 8.3% in ALTPS.The in-hospital morbidities were 5.9% and 8.3% for anterior approach ALPPS and ALTPS,respectively,which were 0 in the other three modified groups.Clinical response evaluation,including R0 resection rate,overall survival rate,disease-free and recurrence rates were merely presented 83.3%,80%,50%,50% in m-ALPPS group,while 100%,100%,95%,5% in modified ALTPS group.Conclusion Modified ALPPS with improved safety is feasible in clinical practice.However,the effectiveness still needs further studies.

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作者: 张韩静 [1] 朱柱 [1] 戴小明 [1] 罗礼炳 [1] 罗加兴 [1]
期刊: 《中华肝胆外科杂志》2016年22卷9期 597-601页 ISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1007-8118.2016.09.005
发布时间: 2016-11-10
基金项目:
湖南省卫生计生委科研基金 南华大学研究生创新基金 Scientific Research Foundation of Health and Family Planning Commission of Hunan Province Graduate Student Innovation Foundation of University of South China
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