Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_819_Библиотеки_им_академика_М_И_Перельмана
.pdf
212
20 Associating Liver Partition andPortal Vein Ligation forStaged Hepatectomy (ALPPS)
20.12 Comparison Between ALPPS
andtheConventional Two-Staged
Operation Using Portal Vein
Embolization PVE/Portal Vein
Ligation PVL
The results are best shown in Tables 20.1 and 20.2.
In a reply to a Letter to the Editor, Aloia stated, ‘after
portal vein embolization or portal vein ligation, liver hypertrophy was 34% when compared with ALPPS it was 77%’.
Table 20.1 ALPPS versus conventional two-staged operation using
PVE/PLV, a retrospective study by Shindol etal. (2013)
PVE/PVL ALPPS
n 144 25
Liver hypertrophy 62% 74%
Complications 33% 40%
Bile leak 5.8%
Sepsis 0.7%
Reoperation 2.9%
Liver related mortality 5.7% 12%
Unable to go to denitive liver resection 27.8% 0%
a
Signicant difference
Table 20.2 ALPPS versus conventional staged operations using PVE/
PVL
PVE/PVL ALPPS
n 83 48
90-Day operative mortality 6% 15%
Liver failure 9% 13%
R
resection 66% 83%
0
Recurrence/12months 52% 54%
A retrospective study by Schadde etal. (2014)
a
a
a
24%
20%
28%
a
a
a
Thus after PVE/PVL, liver hypertrophy was slower and
was less than after ALPPS.
20.13 Conclusions
ALPPS is a technically demanding operation. It is a new
operation and it is a very controversial operation. Short-term
studies reveal that ALPPS can increase the R0 resection rate
for advanced liver tumours, but at a price of high operative
and morbidity rates. The mid-term oncological results are
beginning to surface, and the results are acceptable. However,
there is little data on the long-term oncological results after
ALPPS.There is also little data on liver hypertrophy after
ALPPS in cirrhosis.
Further Reading
Bertens KA, Hawel J, Lung K, et al. ALPPS Challenging the
concept of unresectability—a systematic review. Int J Surg.
2015;12:280–7.
Chia NH, Lai ECH, Lau WY.Associating liver partition and portal vein
ligation for a patient with hepatocellular carcinoma with a background of hepatitis B related brotic liver. Int J Surg Case Rep.
2014;5:1077–81.
Zhang GQ, Zhang ZW, Lau WY, et al. Associating liver partition
and portal vein ligation for staged hepatectomy (ALPPS): a
new strategy to increase resectability in liver surgery. Int J Surg.
2014;12:437–41.
Соседние файлы в папке Библиотека им академика М.И. Перельмана