Application of associating liver partition and portal vein ligation for staged hepatectomy for initially unresectable hepatocellular carcinoma.
Application of associating liver partition and portal vein ligation for staged hepatectomy for initially unresectable hepatocellular carcinoma.
复制标题
联合肝脏分割和门静脉结扎在初次不可切除的肝细胞癌分期肝切除中的应用
DOI：
10.1186/s12893-022-01848-w
复制
发表时间：
2022-11-24
期刊：
影响因子：
1.9
通讯作者：
Wang, Genshu
中科院分区：
文献类型：
--
作者：
Chen, Haoqi;Wang, Xiaowen;Zhu, Wenfeng;Li, Yang;Yu, Zhenyu;Li, Hua;Yang, Yang;Zhu, Shuguang;Chen, Xiaolong;Wang, Genshu
目的评价肝分割联合门静脉结扎分期肝切除术（ALPPS）治疗初治不能切除的乙型肝炎病毒（B virus，HBV）相关肝癌（HCC）的安全性和有效性，并初步探讨未来残肝（FLR）快速生长的机制。回顾性研究了2014年8月至2021年1月在我院接受ALPPS的24例HBV相关HCC患者。使用倾向评分匹配来比较接受ALPPS和经动脉化疗栓塞（TACE）治疗的患者的肿瘤结局。检测两阶段ALPPS后肝组织中雅普和JNK的表达。中位标准肝脏体积（SLV）为1471.4 ml。第二期ALPPS术前中位FLR增加了74.4%，中位FLR/SLV从26.1%增加到41.6%。22例（91.7%）患者在中位间隔15（9-24）d后接受分期肝切除术。ALPPS组的术后并发症总发生率为54.5%，其中Clavien-Dindo ≥ IIIb的术后并发症（需要在全麻下进行手术、内镜或放射干预）为9.1%。ALPPS组与TACE组总并发症发生率差异无统计学意义，但TACE组III级以上并发症发生率低于ALPPS组。腹腔镜ALPPS手术并发症发生率低于开腹手术。ALPPS组1、2、5年生存率分别为71.4%、33.3%、4.8%。间隔时间是与总生存率相关的独立危险因素。ALPPS组和TACE组的总生存率无显著差异。对于晚期HCC（BCLC B和C期），ALPPS组的总生存率并不优于TACE组上级。二期手术后残余肝组织中雅普和p-JNK的表达高于一期手术后，且雅普和p-JNK在残余肝组织中存在共表达。ALPPS是一种安全有效的治疗原发性不可切除的HBV相关HCC的方法。腹腔镜技术可提高ALPPS的疗效。雅普和JNK通路可能参与了ALPPS过程中FLR的快速增加。在线版本包含补充材料，可通过10.1186/s12893-022-01848-w获得。
To evaluate the safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of initially unresectable hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) and to preliminarily explore the mechanism of rapid growth of the future liver remnant (FLR). Twenty-four patients with HBV-associated HCC who underwent ALPPS in our hospital from August 2014 to January 2021 were retrospectively studied. Propensity score matching was used to compare oncologic outcomes of patients treated with ALPPS and transarterial chemoembolization (TACE). The expression of YAP and JNK in liver tissue after two stages of ALPPS were detected. The median standard liver volume (SLV) was 1471.4 ml. Before second stage of ALPPS, the median FLR increased by 74.4%, and the median FLR/SLV increased from 26.1 to 41.6%. Twenty-two patients (91.7%) received staged hepatectomy after a median interval of 15 (9–24) d. The total incidence of postoperative complications in ALPPS group was 54.5%, and of Clavien–Dindo ≥ IIIb postoperative complications (requiring surgical, endoscopic or radiological intervention under general anesthesia) was 9.1%. There was no significant difference in total complications between ALPPS group and TACE group, but there were lower rate of above grade III complications in the TACE group than that in the ALPPS group. The incidence of complications was lower in laparoscopic-ALPPS than that in open surgery. In ALPPS group, the 1-year, 2-year and 5-year overall survival rate were respectively 71.4%, 33.3% and 4.8%. Interval time was an independent risk factor associated with overall survival rate. There was no significant difference in overall survival rate between ALPPS group and TACE group. For advanced HCC (BCLC stage B and C), ALPPS group was not superior to TACE group in overall survival rate. The expression of YAP and p-JNK in the residual liver tissue after second stage procedure was higher than that after first stage procedure, and the co-expression of YAP and p-JNK was observed in the residual liver tissue. ALPPS is a safe and effective treatment for initially unresectable HBV-associated HCC. Laparoscopic technique might improve the effect of ALPPS. YAP and JNK pathway might take a role in rapid FLR increase in ALPPS procedure. The online version contains supplementary material available at 10.1186/s12893-022-01848-w.
登录
查看更多内容
影响因子：
9
作者：
Schnitzbauer, Andreas A.;Lang, Sven A.;Schlitt, Hans J.
通讯作者：
Schlitt, Hans J.
影响因子：
5.6
作者：
Lee J;Jung Y;Jeong SW;Jeong GH;Moon GT;Kim M
通讯作者：
Kim M
影响因子：
9
作者：
Petrowsky, Henrik;Gyoeri, Georg;Clavien, Pierre-Alain
通讯作者：
Clavien, Pierre-Alain
影响因子：
2.6
作者：
Schadde, Erik;Ardiles, Victoria;Clavien, Pierre-Alain
通讯作者：
Clavien, Pierre-Alain
影响因子：
9
作者：
Dindo, D;Demartines, N;Clavien, PA
通讯作者：
Clavien, PA