Nagino M, Kamiya J, Kanai M, Uesaka K, Sano T, Yamamoto H, Hayakawa N, Nimura Y
1st Department of Surgery, Nagoya University School of Medicine, Japan.
Surgery. 2000 Feb;127(2):155-60. doi: 10.1067/msy.2000.101273.
Right portal vein embolization has become popular in preparation for right hepatic lobectomy. However, right trisegment portal vein embolization (R3PE) is not well established.
We performed R3PE in 15 patients with biliary tract carcinoma and 1 patient with primary sclerosing cholangitis. We used 2 types of 5.5 F triple-lumen balloon catheters to embolize portal branches of the right trisegment (the left medial, the right anterior, and the right posterior segments).
R3PE was successful in all patients without any complications. The calculated volume of the right lobe significantly (P < .01) decreased from 650 +/- 161 cm3 before embolization to 585 +/- 143 cm3 after embolization; the volume of the left lateral segment significantly (P < .0005) increased from 240 +/- 58 cm3 to 361 +/- 66 cm3. The volume of the left medial segment was unchanged. The volume gain of the left lateral segment was larger in patients with R3PE than in those patients (n = 41) with right portal vein embolization (122 +/- 39 cm3 vs 66 +/- 35 cm3; P < .0001). Two of the 16 patients underwent only laparotomy because of peritoneal dissemination, and the remaining 14 patients underwent right hepatic trisegmentectomy with caudate lobectomy. In addition, portal vein resection was also performed in 5 patients, and pancreatoduodenectomy and right hemicolectomy was performed in 3 patients. One patient died of posthepatectomy liver failure 87 days after surgery, a mortality rate of 7.1% (1/14 patients).
R3PE is more useful than standard right portal vein embolization in preparation for right hepatic trisegmentectomy and has the potential to increase the safety of this high-risk surgery for patients with biliary tract carcinoma.
右门静脉栓塞术在右肝叶切除术的准备中已变得流行。然而，右三段门静脉栓塞术（R3PE）尚未得到充分确立。
我们对15例胆管癌患者和1例原发性硬化性胆管炎患者进行了R3PE。我们使用2种类型的5.5F三腔球囊导管栓塞右三段（左内侧、右前和右后段）的门静脉分支。
所有患者的R3PE均成功，无任何并发症。计算得出右叶体积从栓塞前的650±161 cm³显著（P <.01）降至栓塞后的585±143 cm³；左外侧段体积从240±58 cm³显著（P <.0005）增加至361±66 cm³。左内侧段体积未改变。R3PE患者左外侧段的体积增加量大于接受右门静脉栓塞术的患者（n = 41）（122±39 cm³对66±35 cm³；P <.0001）。16例患者中有2例因腹膜播散仅接受了剖腹手术，其余14例患者接受了右肝三段切除术加尾状叶切除术。此外，5例患者还进行了门静脉切除术，3例患者进行了胰十二指肠切除术和右半结肠切除术。1例患者术后87天死于肝切除术后肝衰竭，死亡率为7.1%（1/14例患者）。
在准备右肝三段切除术时，R3PE比标准的右门静脉栓塞术更有用，并且有可能提高胆管癌患者这种高风险手术的安全性。
