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联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)作为一种全新的手术方式,为许多剩余肝脏体积不足,采用其他方法无法切除的巨大肝癌或多发性肝癌病人提供了治愈性切除的机会,显示出确切疗效和广阔应用前景,引起了国际肝胆外科领域的广泛关注。尽管ALPPS的适应证不断拓展,但其最佳适应证仍为结直肠癌肝转移。通过严格把握手术指征,不断改进技术,尤其是腹腔镜、手术机器人及射频等微创技术的应用,ALPPS的围手术期并发症发生率和病死率已显著降低。现有的研究结果显示,ALPPS应用于结直肠癌肝转移的治疗安全、可行,可获得良好的远期肿瘤学结果,但尚需大样本、前瞻性随机对照研究进一步证实。目前,亟需进一步规范、完善ALPPS系列技术方法,总结技术要点和并发症防治措施,明确其适应证和禁忌证,并制定实施规范。
Combined hepatic septum and portal vein ligated two-step hepatectomy (ALPPS) as a new surgical approach provides many patients with hepatic or multiple hepatocellular carcinoma who have unremovable hepatocellular carcinoma and other liver cancers with the opportunity for curative resection. , Showed the exact efficacy and broad application prospects, caused widespread concern in the field of international hepatobiliary surgery. Although the indication for ALPPS continues to expand, its best indication is still liver metastasis of colorectal cancer. By strictly grasping the surgical indications and continuously improving the techniques, especially the application of laparoscopic, surgical robots, and radiofrequency and other minimally invasive techniques, the perioperative complications and mortality of ALPPS have been significantly reduced. The existing research results show that ALPPS is safe and feasible for the treatment of colorectal liver metastases, and can obtain good long-term oncologic results, but it still needs a large sample and prospective randomized controlled studies to further confirm. At present, it is necessary to further standardize and improve the ALPPS series of technical methods, summarize technical points and preventative measures for complications, clarify its indications and contraindications, and formulate implementation specifications.