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World Journal of Gastrointestinal Surgery 2018年第1期10卷 1-5页

作者： Sami Akbulut Egemen Cicek Mehmet Kolu Tevfik Tolga Sahin Sezai Yilmaz Department of Surgery and Liver Transplant Institute Inonu University Faculty of Medicine Department of Radiology Inonu University Faculty of Medicine

Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins(R0) may lead to serious complications such as liver failure. In the present case report, we used associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy(ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for marginnegative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.

关键词： Alveolar echinococcosis Extensive disease associating liver partition portal vein ligation Curative management

Current status of associating liver partition with portal vein ligation for staged hepatectomy: Comparison with two-stage hepatectomy and strategies for better outcomes

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World Journal of Gastroenterology 2019年第43期25卷 6373-6385页

作者： Kin Pan Au Albert Chi Yan Chan Department of Surgery Queen Mary HospitalHong KongChina Department of Surgery and State Key Laboratory for Liver Research The University of Hong KongHong KongChina

Since its introduction in 2012,associating liver partition with portal vein ligation for staged hepatectomy(ALPPS)has significantly expanded the pool of candidates for liver *** offers patients with insufficient liver function a chance of a *** is most controversial when its high morbidity and mortality is *** mortality is usually a result of posthepatectomy liver failure and can be minimized with careful patient *** patients have limited reserve for tolerating the demanding *** with colorectal liver metastasis have normal liver and are ideal *** for cholangiocarcinoma is technically challenging and associated with fair *** with hepatocellular carcinoma have chronic liver disease and limited parenchymal ***,in selected patients with limited hepatic fibrosis satisfactory outcomes have been *** the inter-stage period,serum bilirubin and creatinine level and presence of surgical complication predict mortality after stage *** growth rate and hepatobiliary scintigraphy also guide the decision whether to postpone or omit stage II *** outcomes of ALPPS have been improved by a combination of technical *** patients with challenging anatomy,partial ALPPS potentially reduces morbidity,but remnant hypertrophy may compare unfavorably to a complete *** compared to conventional two-stage hepatectomy with portal vein embolization or portal vein ligation,ALPPS offers a higher resection rate for colorectal liver metastasis without increased morbidity or *** ALPPS has obvious theoretical oncological advantages over two-stage hepatectomy,the long-term outcomes are yet to be determined.

关键词： associating liver partition with portal vein ligation for staged hepatectomy Two-stage hepatectomy Patient selection Surgical outcomes

maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model

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World Journal of Gastroenterology 2018年第10期24卷 1107-1119页

作者： Yi-fan Tong Ning Meng Miao-qin Chen Han-ning Ying Ming Xu Billy Lu Jun-Jie Hong Yi-fan Wang Xiujun Cai Department of General Surgery Sir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhou 310000Zhejiang ProvinceChina Department of General Surgery Second HospitalSchool of MedicineHangzhou Normal UniversityHangzhou 310000Zhejiang ProvinceChina Department of Biological Treatment Research Center Sir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhou 310000Zhejiang ProvinceChina National Center for Advancing Translational Science/National Institutes of Health(NIH) Rickville 20850American Samoa

AIM To establish a rat model for evaluating the maturity of liver regeneration derived from associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).METHODS In the present study, ALPPS, partial hepatecotmy(PHx), and sham rat models were established initially, which were validated by significant increase of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1. In the setting of accelerated proliferation in volume at the second and fifth day after ALPPS, the characteristics of newborn hepatocytes, as well as specific markers of progenitor hepatic cell, were identified. Afterwards, the detection of liver function followed by cluster analysis of functional gene expression were performed to evaluate the *** Compared with PHx and sham groups, the proliferation of f LR was significantly higher in ALPPS group(P = 0.023 and 0.001 at second day, P = 0.034 and P < 0.001 at fifth day after stage I). Meanwhile, the increased expression of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1 verified the accelerated liver regeneration derived from ALPPS procedure. However, ALPPS-induced Sox9 positive hepatocytes significantly increased beyond the portal triad, which indicated the progenitor hepatic cell was potentially involved. And the characteristics of ALPPSinduced hepatocytes indicated the lower expression of hepatocyte nuclear factor 4 and anti-tryptase in early proliferative stage. Both suggested the immaturity of ALPPS-derived liver regeneration. Additionally, the detection of liver function and functional genes expression confirmed the immaturity of renascent hepatocytes derived in early stage of ALPPS-derived liver *** Our study revealed the immaturity of ALPPS-derived proliferation in early regenerative response, which indicated that the volumetric assessment overestimated the functional proliferation. This could be convincing evidence that

关键词： associating liver partition and portal vein ligation for staged hepatectomy Liver regeneration Hepatic progenitor cell Function Immature

Rescue associating liver partition and portal vein ligation for staged hepatectomy after portal embolization: Our experience and literature review

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World Journal of Clinical Oncology 2017年第4期8卷 351-359页

作者： Charlotte Maulat Antoine Philis Bérénice Charriere Fatima-Zohra Mokrane Rosine Guimbaud Philippe Otal Bertrand Suc Fabrice Muscari Department of Visceral Surgery Toulouse-Rangueil University Hospital Department of Radiology Toulouse-Rangueil University Hospital Department of Digestive Oncology Toulouse-Rangueil University Hospital

AIM To report a single-center experience in rescue associating liver partition and portal vein ligation for staged hepatectomy(ALPPS), after failure of previous portal embolization. We also performed a literature *** Between January 2014 and December 2015, every patient who underwent a rescue ALPPS procedure in Toulouse Rangueil University Hospital, France, was included. Every patient included had a project of major hepatectomy and a previous portal vein embolization(PVE) with insufficient future liver remnant to body weight ratio after the procedure. The ALPPS procedure was performed in two steps(ALPPS-1 and ALPPS-2), separated by an interval phase. ALPPS-2 was done within 7 to 9 d after ALPPS-1. To estimate the FLR, a computed tomography scan examination was performed 3 to 6 wk after the PVE procedure and 6 to 8 d after ALPPS-1. A transcystic stent was placed during ALPPS-1 and remained opened duringthe interval phase, in order to avoid biliary complications. Postoperative liver failure was defined using the 50-50 criteria. Postoperative complications were assessed according to the Dindo-Clavien *** From January 2014 to December 2015, 7 patients underwent a rescue ALPPS procedure. Median FLR before PVE, ALPPS-1 and ALPPS-2 were respectively 263 cc(221-380), 450 cc(372-506), and 660 cc(575-776). Median FLR/BWR before PVE, ALPPS-1 and ALPPS-2 were respectively 0.4%(0.3-0.5), 0.6%(0.5-0.8), and 1%(0.8-1.2). Median volume growth of FLR was 69%(18-92) after PVE, and 45%(36-82) after ALPPS-1. The combination of PVE and ALPPS induced a growth of median initial FLR of +408 cc(254-513), leading to an increase of +149%(68-199). After ALPPS-2, 4 patients had stage Ⅰ-Ⅱ complications. Three patients had more severe complications(one stage Ⅲ, one stage Ⅳ and one death due to bowel perforation). Two patients suffered from postoperative liver failure according to the 50/50 criteria. None of our patients developed any biliary complication during the A

关键词： Rescue associating liver partition and portal vein ligation for staged hepatectomy associating liver partition and portal vein ligation for staged hepatectomy Portal vein embolization Liver resection Future liver remnant

Mechanistic insights of rapid liver regeneration after associating liver partition and portal vein ligation for stage hepatectomy

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World Journal of Gastroenterology 2016年第33期22卷 7613-7624页

作者： Demetrios Moris Spyridon Vernadakis Alexandros Papalampros Michail Vailas Nikolaos Dimitrokallis Athanasios Petrou Dimitrios Dimitroulis Department of Immunology Lerner Research InstituteCleveland Clinic Foundation Laikon General hospital National and Kapodistrian University of Athens

AIM To highlight the potential mechanisms of regeneration in the associating Liver Partition and Portal vein ligation for Stage hepatectomy models(clinical and experimental) that could unlock the myth behind the extraordinary capability of the liver for regeneration,which would help in designing new therapeutic options for the regenerative drive in difficult setup,such as chronic liver diseases. associating Liver Partition and Portal vein ligation for Stage hepatectomy has been recently advocated to induce rapid future liver remnant hypertrophy that significantly shortens the time for the second stage hepatectomy. The introduction of associating Liver Partition and Portal vein ligation for Stage hepatectomy in the surgical armamentarium of therapeutic tools for liver surgeons represented a real breakthrough in the history of liver surgery. METHODS A comprehensive literature review of associating Liver Partition and Portal vein ligation for Stage hepatectomy and its utility in liver regeneration is performed. RESULTS Liver regeneration after associating Liver Partition and Portal vein ligation for Stage hepatectomy is a combination of portal flow changes and parenchymal transection that generate a systematic response inducing hepatocyte proliferation and remodeling. CONCLUSION associating Liver Partition and Portal vein ligation for Stage hepatectomy represents a real breakthrough in the history of liver surgery because it offers rapid liver regeneration potential that facilitate resection of liver tumors that were previously though unresectable. The jury is still out though in terms of safety,efficacy and oncological outcomes. As far as associating Liver Partition and Portal vein ligation for Stage hepatectomy-induced liver regeneration is concerned,further research on the field should focus on the role of nonparenchymal cells in liver regeneration as well as on the effect of associating Liver Partition and Portal vein ligation for Stage hepatectomy in liver regener

关键词： Liver regeneration associating liver partition with portal vein ligation for staged hepatectomy Portal vein embolization Portal vein ligation Liver transection

Arterial ischemia in the deportalized liver following associating liver partition and portal vein ligation for staged hepatectomy

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世界肝病学杂志：英文版（电子版） 2015年第23期7卷 2492-2496页

作者： Srinivas Sanjeevi Ernesto Sparrelid Stefan Gilg Eduard Jonas Bengt Isaksson Department of Surgical Gastroenterology Karolinska University Hospital Division of Surgery Department of Clinical Science Intervention and Technology (CLINTEC) Karolinska Institutet

associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) is a novel 2-stage technique intended to induce rapid growth of the future liver remnant(FLR). Initial reports of a 12% mortality rate have sparked debate regarding the safety of the procedure. A 64 years old male was planned for a rightsided hemi-hepatectomy due to colorectal cancer liver metastases. Intra-operatively it was decided to convert to an ALPPS due to unexpectedly small segments 2-4. Post-operative serum laboratory tests indicated an acute liver failure and radiological imaging showed no sign of arterial blood flow to the right hemi-liver. A computed tomography examination on post-operative day 3 revealed that the FLR had increased from 290 to 690 m L in 3 d(138% growth). In the following days serum values gradually improved and stage 2 was carried out on post-operative day 7. The rest of the hospital stay was uneventful and the patient made a full recovery. ALPPS is a fascinating advancement in liver surgery. Despite severe post-operative complications, in properly selected cases it provides successful outcomes that other modalities of treatment cannot offer.

关键词： associating liver partition and portal vein ligati

An Alternative Way towards Preparation of Hydrophobically associating Polyacrylamide: Chemical Post-Modification

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合成化学 2004年第Z1期12卷 86-86页

作者： FENG Yu-jun Chengdu Institute of Organic Chemistry Chinese Academy of Sciences No. 9 Section 4 Ren Min South Avenue Chengdu 610041 China

Hydrophobically associating polyacrylamides (HAPAMs) are derivatives from polyacrylamides by incorporating a small amount of hydrophobic moieties along the water-soluble mainchain. They are now becoming a class of promising candidates as thickeners or rheology modifiers in the formulations where rheology is necessary to be regulated, such as tertiary oil recovery, drilling fluids, hydraulic fracturing and coatings. Due to association of hydrophobes in nano-domains, their aqueous solutions exhibit very interesting rheological properties and better stability against salts than the unmodified precursor, ***, there are two synthetic routes to introduce hydrophobic portion onto water-soluble polymer chains; i.e., direct copolymerization of hydrophobic and hydrophilic monomers, and post-polymerization functionalization[1]. In the case of HAPAM polymers, a commonly accepted method is micellar copolymerization in which an appropriate surfactant is employed to solubilize both monomers. However, it is widely reported[2] that the obtained polymers via micellar polymerization are characterized by: (i) blocky distribution of the hydrophobes; (ii) compositional inhomogeneity and (iii) strong dependence of solution properties on the block *** this work, the alternative process, i.e., chemical post-modification, is employed to synthesize HAPAM polymers by direct N-alkylation of parent polyacrylamide (Figure 1) in dimethyl sulfoxide[3,4].PAM HAPAMFig. 1 Schematic route to prepare HAPAM by direct N-alkylation of PAMIt is found that the final incorporation of hydrophobic groups is in good agreement with the feed ratio[4], in contrast with that from micellar copolymerization which always brings about composition drift. Furthermore, unique rheological responses to shear rate, salt, temperature are also evidenced[5].

关键词： hydrophobically associating polyacrylamide, chemical post-modification, water-soluble polymer

Hepatocellular carcinoma successfully treated with ALPPS and apatinib: A case report

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World Journal of Clinical Cases 2019年第16期7卷 2384-2392页

作者： Ling Liu Nian-Feng Li Qi Zhang Ling Lin Department of Hepatobiliary and Pancreatic Surgery Xiangya Hospital Central South University

BACKGROUND associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has becoming ever more recognized in the treatment of hepatocellular carcinoma (HCC).Nevertheless,long-term survival rate and postoperative complications are far from ideal,mainly since the majority of patients treated with ALPPS surgery have large or multiple lesions and microvascular tumor *** SUMMARY We present the case of a 47-year-old male patient with a huge right hepatic mass and an estimated insufficient residual liver,who was successfully treated with ALPPS surgery and *** pathology revealed HCC with several significant microvascular *** months after operation,no tumor reoccurrence was *** Our case indicated that combined targeted drug therapy with ALPPS can lead to long-term survival for patients with large HCC.

关键词： Hepatocellular carcinoma associating liver partition and portal vein ligation for staged hepatectomy Apatinib Case report

Monosegment ALPPS hepatectomy preserving segment 4 for colorectal liver metastases:literature review and our experience

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Hepatobiliary Surgery and Nutrition 2018年第2期7卷 105-115页

作者： Fiammetta Soggiu Francesco Giovinazzo Jack Straiton Giulia Turri Jim Phillips Bassam Al-Kari Irfan Ahmed Mohammad Habib Hepatobiliary and Pancreatic Surgery Unit NHS GrampianAberdeenUK Department of Radiology NHS GrampianAberdeenUK

Monosegment 4±1 associating Liver Partition and Portal Vein ligation for Staged hepatectomy(ALPPS)for bilateral colorectal liver metastases decreases the risk of drop-out of two stage hepatectomy,triggering a rapid and significant increase in future liver remnant(FLR)with promising oncological *** report two cases of segment 4+1 monosegment ALPPS for multiple colorectal liver metastases performed at our *** the literature,seven similar cases have been *** and long term outcomes of our two patients were reported along with a review of data from the *** patients showed a FLR increase from 13%to 37%and from 14%to 41%of total liver volume,*** was compared to a median growth from 19%at baseline to 34%before stage 2,in the *** 20 and 27 months since resection both patients are alive and *** the literature,median overall survival and disease free survival were 13 months(range,5–24 months)and 5 months(range,3–23 months),*** 4±1 ALPPS is associated with promising oncological outcomes and a significant FLR *** may be safely performed in selected patients as a salvage procedure,reducing the risk of the dropout of two-stage hepatectomy.

关键词： associating Liver Partition and Portal Vein ligation for Staged hepatectomy(ALPPS) liver resection colorectal liver metastases

Surgical strategy for huge and advanced hepatocellular carcinoma in Hong Kong

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Hepatoma Research 2017年第9期3卷 189-195页

作者： Kenneth S.H.Chok Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation Department of SurgeryThe University of Hong KongHong KongChina

In Hong Kong, surgical resection is the core curative treatment for huge and advanced hepatocellular carcinoma (HCC). For tumors measuring 10 cm or above, major hepatectomy is usually required, but a future liver remnant not large enough will preclude the operation. Hypertrophy of future liver remnant is a way to render more patients operable, and measures include portal vein embolization and associating liver partition and portal vein ligation for staged hepatectomy. For HCC that has invaded a major vessel, en bloc resection with immediate vessel reconstruction is necessary if thrombectomy would not suffice. In case of bilobar involvement, radiofrequency ablation is a useful adjuctive therapy. In the treatment of extrahepatic metastasis, metastasectomy offers a cure to properly selected patients.

关键词： associating liver partition and portal vein ligation staged hepatectomy hepatocellular carcinoma liver resection vascular resection and reconstruction radiofrequency ablation