■增加未来肝脏残留(FLR)的技术从根本上改变了成人肝脏手术可切除性的适应症和标准。然而,在儿科患者中,这些程序很少被应用,潜在的益处或危害以及合适的适应症尚不清楚.
■MEDLINE系统文献检索,WebofScience,中央进行了。基于PRISMA标准,预定义的方法,纳入了所有报告儿科患者(<18y)接受肝切除术,并将肝分区和门静脉结扎联合进行分期肝切除术(ALPPS)或术前门静脉栓塞或结扎(PVE/PVL)的研究.基线数据,介入性发病率,分析了FLR的增加和结局。
■15项研究报告21名儿科患者,平均年龄为4岁7个月(范围1.8个月-17岁)。12ALPPS程序,进行了8个PVE和1个PVL。进行ALPPS或PVE的应用标准是异质的,最低可接受的FLR的阈值也有所不同。ALPPS组干预前的平均FLR[占总肝脏体积的百分比]为23.6%(范围15.0-39.3%),PVE组为31.4%(范围21.5-56.0%)。ALPPS在2期切除前FLR的平均增加为69.4%(范围19.0-103.8%),PVE后为62.8%(范围25.0-108.0%)。术后无死亡发生,报告1例ALPPS术后早期肝内复发.术后总发病率为23.8%。
■在小儿肝切除术中缺乏经验证的最小FLR标准,ALPPS或PVE的明确适应症也是如此。在特殊情况下,ALPPS和PVE可以是完成小儿肝肿瘤完整切除的有价值的技巧。然而,需要更多的数据,未来的研究应集中在对接受扩大肝切除术的小儿患者的肝切除术后肝功能衰竭的定义和验证以及最低限度的FLR。
■[www.clinicaltrials.gov],标识符[PROSPERO2021CRD42021274848]。
UNASSIGNED: Techniques to increase the future liver remnant (FLR) have fundamentally changed the indications and criteria of resectability in adult liver surgery. In pediatric patients however, these procedures have rarely been applied and the potential benefit or harm as well as suited indications are unclear.
UNASSIGNED: A systematic literature search of MEDLINE, Web of Science, and CENTRAL was conducted. Based on a PRISMA-compliant, predefined methodology, all studies reporting pediatric patients (< 18y) undergoing liver resection with either associating liver partition and portal vein ligation for stages hepatectomy (
ALPPS) or preoperative portal vein embolization or ligation (PVE/PVL) were included. Baseline data, periinterventional morbidity, increase of FLR and outcomes were analyzed.
UNASSIGNED: 15 studies reporting on 21 pediatric patients with a mean age of 4 years and 7 months (range 1.8 months - 17 years) were included. 12 ALPPS procedures, 8 PVE and 1 PVL were performed. The applied criteria for performing ALPPS or PVE were heterogenous and thresholds for minimally acceptable FLR varied. Mean FLR [% of total liver volume] before the intervention was 23.6% (range 15.0 - 39.3%) in the
ALPPS group and 31.4% (range 21.5 - 56.0%) in the PVE group. Mean increase of FLR before stage 2 resection was 69.4% (range 19.0 - 103.8%) for
ALPPS and 62.8% (range 25.0 - 108.0%) after PVE. No postoperative death occurred, one early intrahepatic recurrence after an
ALPPS procedure was reported. Overall postoperative morbidity was 23.8%.
UNASSIGNED: Validated criteria for minimal FLR in pediatric liver resection are lacking and so are clear indications for ALPPS or PVE. In special cases,
ALPPS and PVE can be valuable techniques to achieve complete resection of pediatric liver tumors. However, more data are needed, and future studies should focus on a definition and validation of posthepatectomy liver failure as well as the minimally needed FLR in pediatric patients undergoing extended hepatectomy.
UNASSIGNED: [www.clinicaltrials.gov], identifier [PROSPERO 2021 CRD42021274848].