Abstract:

Surgical Modifications on the Conventional ALPPS                    LAU Wan Yee，LAU Stephanie H.Y. Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Corresponding author: Lau W.Y， E-mail: josephlau@cuhk.edu.hk
Abstract    Since the introduction of ALPPS, this operation has created a lot of controversies in the international surgical scene. Some surgeons have rapidly adopted this procedure as within a short time, ALPPS can convert a locally unresectable and non-curable liver cancer to become resectable and curable. Others objected this procedure because it has high morbidity and mortality rates.To improve on the indications of ALPPS, and at the same time, to reduce the operative morbidity and mortality rates, surgeons around the world started to make minor and major modifications of ALPPS. Up to now, when the future liver remnant is inadequate, there are only two ways to induce the future liver remnant to hypertrophy to an adequate size to allow resectional surgery:- ALPPS and the traditional two-stage operation (stage one portal vein embolization or ligation, stage 2 partial hepatectomy). These two operations have their own merits and demerits and the authors tried to compare these procedures based on previously reported data and evidences.

Key words: associating liver partition and portal vein ligation for staged hepatectomy（ALPPS）, minimally invasive surgery, percutaneous thermal ablation

摘要：

联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）手术诞生后,在国际上引起非常大的争议。由于该手术可短期内把不能切除的肝癌变成为可切除，因此,很快便得到不同国家的外科医生支持。但因该手术的病死率和并发症发生率高，也受到不同国家的外科医生反对。为了改善ALPPS的适应证和降低术后病死率和并发症发生率，外科医生对传统ALPPS进行了改进和变异。所谓改进，即手术术式的小改变。所谓变异，即把手术术式的整体改变。到目前为止，如剩余肝脏体积不足，只有两种方法来使剩余肝脏增生，即ALPPS或传统二期手术（第一期门静脉栓塞或结扎，第二期部分肝切除）。这两种方法各有优劣。

关键词: 联合肝脏分隔和门静脉结扎的二步肝切除术, 微创手术, 经皮消融