扩大右半肝切除术前的门静脉栓塞术。

Portal vein embolisation prior to extended right-sided hepatic resection.

作者信息

Liem M S L, Liu C L, Tso W K, Lo C M, Fan S T, Wong J

机构信息

The Dutch Cancer Society, Queen Wilhelmina Fund, Amsterdam, The Netherlands.

出版信息

Hong Kong Med J. 2005 Oct;11(5):366-72.

PMID:16219956

Abstract

OBJECTIVES

To determine whether preoperative portal vein embolisation improves the operative outcome of patients undergoing extended right-sided hepatic resection for hepatobiliary malignancy.

DESIGN

Prospective non-randomised study.

SETTING

University teaching hospital, Hong Kong.

PATIENTS

Ninety-two patients underwent extended right-sided hepatic resection for hepatobiliary malignancy during a 45-month period (January 2000 to September 2003). Among them, 15 (16%) underwent portal vein embolisation via a percutaneous ipsilateral approach (n=9) or through the ileocolic vein with a mini-laparotomy (n=6). The remaining 77 (84%) patients underwent hepatic resection without portal vein embolisation.

MAIN OUTCOME MEASURES

Operative morbidity and mortality.

RESULTS

Patients undergoing portal vein embolisation were older (69 years vs 55 years; P=0.009), and had significantly worse preoperative renal function (creatinine, 96 micromol/L vs 86 micromol/L; P=0.039) and liver function (bilirubin, 23 micromol/L vs 12 micromol/L; P<0.001). Portal vein embolisation resulted in an increase in the future liver remnant of 9% (interquartile range, 7-13%) of the estimated standard liver volume. The operating time for patients receiving portal vein embolisation was significantly longer (medium, 660 min vs 420 min; P<0.001) with more complicated surgery performed in terms of concomitant caudate lobectomy and hepaticojejunostomy. There was no hospital mortality in patients who underwent portal vein embolisation whereas five without the treatment died (P=0.587). The operative morbidity of patients who underwent portal vein embolisation and those who did not was 20% and 30%, respectively (P=0.543).

CONCLUSIONS

In older patients who have worse preoperative liver and renal functions, portal vein embolisation enhances the possibility to perform extended right-sided hepatic resection for hepatobiliary malignancies with potentially lower operative mortality and morbidity.

摘要

目的

确定术前门静脉栓塞术是否能改善接受扩大右半肝切除术治疗肝胆恶性肿瘤患者的手术效果。

设计

前瞻性非随机研究。

地点

香港大学教学医院。

患者

在45个月期间（2000年1月至2003年9月），92例患者接受了扩大右半肝切除术治疗肝胆恶性肿瘤。其中，15例（16%）通过经皮同侧入路（n = 9）或经回结肠静脉行小切口剖腹术（n = 6）进行门静脉栓塞。其余77例（84%）患者未行门静脉栓塞直接接受肝切除术。

主要观察指标

手术并发症发生率和死亡率。

结果

接受门静脉栓塞术的患者年龄较大（69岁对55岁；P = 0.009），术前肾功能（肌酐，96 μmol/L对86 μmol/L；P = 0.039）和肝功能（胆红素，23 μmol/L对12 μmol/L；P < 0.001）明显较差。门静脉栓塞使未来肝脏残余体积增加了估计标准肝脏体积的9%（四分位间距，7 - 13%）。接受门静脉栓塞术的患者手术时间明显更长（中位数，660分钟对420分钟；P < 0.001），且在同时行尾状叶切除术和肝空肠吻合术方面手术更为复杂。接受门静脉栓塞术的患者无医院死亡病例，而未接受治疗的患者中有5例死亡（P = 0.587）。接受门静脉栓塞术和未接受该治疗的患者手术并发症发生率分别为20%和30%（P = 0.543）。