Clinical Research Of Associating Liver Partition And Portal Vein Ligation For Hepatectomy

【Objective】 Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is a kind of new operation,the operation can make future liver remnant(FLR)increased rapidly in a short time,to provide an opportunity for radical resection of liver cancer in patients with residual liver volume deficiency.Clinical data of patients with primary liver cancer(PHC)treated with ALPPS were retrospectively analyzed,to discuss the feasibility and safety of ALPPS in the treatment of liver cancer.【Methods】Six patients who underwent ALPPS surgery for primary liver cancer in the General Surgery Department of Tianjin Medical University General Hospital from January 2016 to June 2018 were selected for this study.Including 4 males and 2 females.The completion rate of the second stage operation,the volume growth rate of the residual liver after the first stage operation and the mortality rate were analyzed.Around ALPPS and traditional staged hepatectomy(TSH)conducted the contrast research of retrieval system,accords with the standard of the research on extracting a postoperative liver volume growth rate,two phase time interval,the second stage surgery completion rate,incidence of postoperative complications and realizing R0 resection rate and 1 year disease-free survival,90-day mortality rate,etc.,to analyze the relevant data.【Results】 All of the six patients completed the two staged surgery,among which one patient died due to severe abdominal infection after the second stage surgery,mortality rate of 16%.To date,three patients have survived for nearly 4 years.The results showed that compared with TSH patients undergoing traditional portal vein ligation(PVL)or portal vein embolization(PVE),the rate of postoperative FLR growth was significantly higher in ALPPS patients,and the difference was statistically significant(WMD 40.25;95% CI,34.01 ～ 46.48;P < 0.00001);The interval time between operations in ALPPS patients was shorter than that in TSH patients,with a significant statistical difference(WMD 26.80;95% CI,33.68 ～ 19.92;P < 0.00001);The surgical completion rate of ALPPS patients was higher than that of TSH patients,and there was a significant statistical difference between the two groups(OR 9.50;95% CI,4.65～19.44;P < 0.00001);The 1-year tumor-free survival rate of ALPPS patients was higher than that of TSH patients,and there was a statistically significant difference between the two groups(OR 0.33;95% CI,0.16～0.70;P = 0.004);There were no significant differences in postoperative complications,90-day mortality and R0 resection rate between ALPPS and TSH cases(P > 0.05).【Conclusion】 Compared with TSH group,ALPPS group was significantly superior to TSH group in FLR growth rate,two-stage surgery completion rate,operation interval and 1-year disease-free survival rate.There were no statistically significant differences in the incidence of postoperative complications(biliary leakage,hepatic failure)and 90-day mortality.