Ku Y, Tominaga M, Sugimoto T, Iwasaki T, Fukumoto T, Takahashi T, Suzuki Y, Kuroda Y
Department of Surgery I, Faculty of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Br J Surg. 2002 Jan;89(1):63-9. doi: 10.1046/j.0007-1323.2001.01955.x.
Liver resection of segments VII and/or VIII sometimes requires segmental resection of the right hepatic vein in patients with liver tumours invading or located close to the hepatic vein. In this situation, hepatic vein reconstruction is thought to have an important role in the postoperative function of segment VI. This study investigated whether preoperative embolization of the major hepatic vein could obviate the need for hepatic vein reconstruction after cranial partial resection of the liver including the major hepatic vein trunk in a preclinical model.
Sixteen beagles were divided into two groups of eight: control group (hepatectomy alone) and hepatic venous embolization (HVE) group (hepatectomy after HVE). HVE was performed 2 weeks before hepatectomy. All dogs underwent resection of the cranial third of the left lateral liver lobe together with the major trunk of the left hepatic vein. Following hepatectomy, survival, histological features, portal venous pressure and serum aspartate aminotransferase (AST) levels were determined.
Six control animals and seven in the HVE group were alive 1 week after hepatectomy. Immediately after hepatectomy, portal venous pressure was significantly higher in the control group compared with the HVE group (mean(s.d.) 14.0(1.1) versus 8.1(1.0) mmHg; P < 0.01). Histological examination of the remnant left lateral lobe demonstrated patchy parenchymal haemorrhage in the control group and normal parenchymal architecture in the HVE group. Peak AST levels were observed on day 1 in both groups and were significantly higher in the control group (mean(s.d.) 182(42) versus 67(40) units/l; P < 0.01).
In this model, preoperative HVE facilitated interlobar venous collateral formation and minimized the untoward effects of segmental hepatic vein resection. This procedure may obviate the need for hepatic vein reconstruction after cranial partial liver resection including the major hepatic vein.
对于肝肿瘤侵犯或靠近肝静脉的患者，肝Ⅶ段和/或Ⅷ段切除术有时需要切除右肝静脉的节段。在这种情况下，肝静脉重建被认为对Ⅵ段的术后功能具有重要作用。本研究在临床前模型中调查了术前对主要肝静脉进行栓塞是否可以避免在包括主要肝静脉主干的肝颅部部分切除术后进行肝静脉重建。
16只比格犬分为两组，每组8只：对照组（单纯肝切除术）和肝静脉栓塞（HVE）组（HVE后肝切除术）。在肝切除术2周前进行HVE。所有犬均切除左外侧肝叶颅部三分之一以及左肝静脉主干。肝切除术后，测定生存率、组织学特征、门静脉压力和血清天冬氨酸转氨酶（AST）水平。
肝切除术后1周，对照组有6只动物存活，HVE组有7只存活。肝切除术后即刻，对照组门静脉压力显著高于HVE组（均值（标准差）14.0（1.1）对8.1（1.0）mmHg；P<0.01）。对残余左外侧叶的组织学检查显示，对照组有斑片状实质出血，HVE组实质结构正常。两组均在第1天观察到AST峰值水平，且对照组显著更高（均值（标准差）182（42）对67（40）单位/升；P<0.01）。
在该模型中，术前HVE促进了叶间静脉侧支形成，并使节段性肝静脉切除的不良影响最小化。该手术可能避免在包括主要肝静脉的肝颅部部分切除术后进行肝静脉重建。
