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Abstract：
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel procedure for major resection in patients with insufficient future liver remnant (FLR). Effective FLR augmentation is pivotal in the completion of ALPPS. Liver fibrosis/cirrhosis associated with chronic viral hepatitis impairs liver regeneration. To investigate the augmentation of FLR in associating ALPPS between patients with fibrotic/cirrhotic livers (FL) and non-fibrotic livers (NFL) and compare their short-term clinical outcomes and long-term survival. Patients were divided into two groups based on the Ishak modified staging: non-fibrotic liver group (NFL, stage 0) and fibrotic/cirrhotic liver group (FL, stage 1-5/6). Weekly liver regeneration in FLR, perioperative data, and survival outcomes were investigated. Twenty-seven patients with liver tumors underwent ALPPS (NFL, n = 7; FL, n = 20). NFL and FL patients had viral hepatitis (28.6% [n = 2] and 95% [n = 19]), absolute FLR volume increments of 134.90 ml and 161.85 ml (p = 0.825), and rates of hypertrophy were 16.46 ml/day and 13.66 ml/day (p = 0.507), respectively. In the FL group, baseline FLR volume was 360.13 ml, postoperatively it increased to a plateau (542.30 ml) in week 2 and declined (378.45 ml) in week 3. One patient (3.7%) with cirrhotic liver (stage 6) failed to proceed to ALPPS-II. The overall ALPPS-related major complication rate was 7.4%. ALPPS is feasible for fibrotic liver patients classified by Ishak modified stages ≤ 5. After ALPPS-I, 14 days for FLR augmentation seems an appropriate waiting time to reach a maximum FLR volume in these patients.
摘要：
联合肝分区和门静脉结扎进行分期肝切除术（ALPPS）是一种新颖的方法，用于未来肝残存量不足（FLR）的患者进行大切除。有效的FLR增强是完成ALPPS的关键。与慢性病毒性肝炎相关的肝纤维化/肝硬化损害肝再生。探讨FLR在纤维化/肝硬化肝(FL)和非纤维化肝(NFL)患者ALPPS相关性中的增强作用，并比较其短期临床结局和长期生存率。根据Ishak改良分期将患者分为两组：非纤维化肝组（NFL，0期)和纤维化/肝硬化肝组(FL，阶段1-5/6）。每周肝脏再生在FLR，围手术期数据,和生存结局进行了调查。27例肝肿瘤患者接受了ALPPS（NFL，n=7；FL，n=20）。NFL和FL患者有病毒性肝炎（28.6%[n=2]和95%[n=19]），绝对FLR体积增量为134.90ml和161.85ml（p=0.825），肥厚率分别为16.46毫升/天和13.66毫升/天（p=0.507），分别。在FL组中，基线FLR体积为360.13ml，术后第2周上升至平台期（542.30ml），第3周下降（378.45ml）。1例肝硬化（6期）患者（3.7％）未能进行ALPPS-II。总体ALPPS相关的主要并发症发生率为7.4%。ALPPS适用于Ishak改良分期≤5的纤维化肝脏患者。ALPPS-I之后,在这些患者中，14天的FLR增强似乎是达到最大FLR量的适当等待时间。
