05/02/2026
🔥🔥主題: 肝癌手術--聯合肝臟分割和門靜脈結紮的分階段肝切除術 (ALPPS）
🖋️ㄧ般外科：侯登原醫師
❇️對於肝癌或轉移性肝腫瘤的病人而言，手術切除仍是最有機會達到長期存活的治療方式。然而，若腫瘤範圍過大，必須切除大部分肝臟時，「未來殘餘肝臟體積（future liver remnant, FLR）」是否足夠，便成為決定手術能否安全進行的關鍵。若剩餘肝臟過少，可能導致術後肝衰竭，風險極高。
❇️為解決此一難題，醫界近年發展出「聯合肝臟分割和門靜脈結紮的分階段肝切除術（ALPPS）」，透過兩階段手術策略，在短時間內促進未來殘餘肝臟快速增生，提高重大肝切除手術的安全性。第一階段先阻斷腫瘤側肝臟的血流，並將肝臟分割，使健康側肝臟在短時間內快速增生；待肝臟體積足夠後，再進行第二階段腫瘤切除。相較於傳統的門靜脈栓塞，ALPPS 可在 1–2 週內誘發更快速的肝臟再生。(圖一)
❇️高雄長庚醫療團隊近期發表研究，分析單一中心在肝臟已有纖維化或早期肝硬化病人中執行 ALPPS 的臨床成果。這類病人多合併 B 型或 C 型肝炎，傳統上被認為肝臟再生能力較差，手術風險較高。研究結果顯示，只要肝硬化程度未達最嚴重階段（Ishak 分期 ≤5），病人的肝臟仍可在術後一至兩週內達到明顯且足夠的體積增生，順利完成第二階段手術，手術成功率與併發症控制皆在可接受範圍內。(圖二)
❇️研究也發現，肝臟再生並非無限增加，而是在約第 14 天達到高峰，之後可能出現體積下降，顯示「適當的等待時間」對手術安全極為重要。這項結果有助醫師更精準規劃第二階段手術時機，避免過早或過晚手術帶來的風險。(圖三)
❇️整體而言，透過精準評估與專業團隊執行，即使合併慢性肝病，先進的肝臟手術仍能為病人帶來更多根治性治療的可能，為肝癌治療策略提供新的臨床證據與希望。
❇️For patients with hepatocellular carcinoma or metastatic liver tumors, surgical resection remains the treatment option most strongly associated with long-term survival. However, when tumors are extensive and require major hepatectomy, the adequacy of the future liver remnant (FLR) becomes the key determinant of surgical safety. An insufficient FLR may result in postoperative liver failure, which carries a high risk of morbidity and mortality.
❇️To address this challenge, a novel surgical strategy known as associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been developed in recent years. This two-stage procedure aims to induce rapid hypertrophy of the future liver remnant within a short period, thereby improving the safety of major liver resections. In the first stage, blood flow to the tumor-bearing liver is interrupted and the liver parenchyma is transected, allowing the contralateral, healthy liver to regenerate rapidly. Once sufficient liver volume is achieved, the second-stage tumor resection is performed. Compared with conventional portal vein embolization, ALPPS can induce much faster liver regeneration, typically within 1–2 weeks.
❇️The Kaohsiung Chang Gung medical team recently published a single-center study evaluating the clinical outcomes of ALPPS in patients with underlying liver fibrosis or early-stage cirrhosis. These patients often have chronic hepatitis B or C and are traditionally considered to have impaired liver regenerative capacity and higher surgical risk. The study demonstrated that as long as cirrhosis had not progressed to the most advanced stage (Ishak fibrosis stage ≤5), patients were still able to achieve significant and adequate liver hypertrophy within one to two weeks after the first-stage procedure. Most patients successfully proceeded to the second-stage operation, with acceptable surgical success rates and well-controlled complication profiles.
❇️Importantly, the study also revealed that liver regeneration is not unlimited. The FLR volume typically peaks around postoperative day 14 and may subsequently decline, highlighting the critical importance of an optimal waiting interval between the two surgical stages. These findings provide valuable guidance for more precise timing of the second-stage operation, helping clinicians avoid the risks associated with surgery performed either too early or too late.
❇️Overall, this study underscores that with careful patient selection and ex*****on by an experienced multidisciplinary team, advanced liver surgery can offer curative opportunities even for patients with chronic liver disease, providing new clinical evidence and hope in the treatment of liver cancer.
🔗Refererence：
[圖一］
Vennarecci, G., Laurenzi, A., Santoro, R., Colasanti, M., Lepiane, P. and Ettorre, G.M. (2014), The ALPPS Procedure: A Surgical Option for Hepatocellular Carcinoma with Major Vascular Invasion. World J Surg, 38: 1498-1503 1. https://doi.org/10.1007/s00268-013-2296-y
[圖二、圖三］
Hung KC, Wang HP, Li WF, Lin YC, Wang CC. Single center experience with ALPPS and timing with stage 2 in patients with fibrotic/cirrhotic liver. Updates Surg. 2024;76(4):1213-1221. doi:10.1007/s13304-024-01782-x.
https://pubmed.ncbi.nlm.nih.gov/38494567/ .
