Capussotti Lorenzo, Muratore Andrea, Ferrero Alessandro, Anselmetti Giovanni Carlo, Corgnier Andrea, Regge Daniele
Surgical Oncology Unit and Radiology Unit, Institute for Cancer Research and Treatment, Candiolo, Italy.
Arch Surg. 2005 Nov;140(11):1100-3. doi: 10.1001/archsurg.140.11.1100.
Routine embolization of segment IV, combined with right portal vein embolization (PVE), has been suggested in patients who are candidates for right trisegmentectomy to induce higher and faster hypertrophy of segments II-III. Our objective was to compare hypertrophy of segments II-III induced by PVE with and without extension to segment IV in patients undergoing major hepatectomy.
Twenty-six consecutive patients were prospectively evaluated; the future remnant liver volume was calculated using the portal phase of spiral computed tomographic scans before and 3 to 4 weeks after right PVE (group R, n = 13), which was extended to segment IV branches in 13 patients (group L).
Twenty patients (76.9%) underwent the scheduled hepatic resection. Of the 6 patients who did not undergo the planned operation, 5 showed disease progression; in 1 patient (group L), there was an insufficient increase of the future remnant liver volume due to the presence of embolizing material in the left lobe. The mean +/- SD time between PVE and volume measurements was 31.8 +/- 9.3 days. The overall mean +/- SD future remnant liver volume increase was 53.1% +/- 24.8%; the increase for segment IV was significantly higher in group R than group L. The mean +/- SD post-PVE volumes of segments II-III and the rate of volume increase were similar in the 2 groups: group R, 348.4 +/- 83.1 cm3 and 67.8% +/- 30.8%, respectively, vs group L, 391.2 +/- 78.05 cm3 and 56.1% +/- 35.1%, respectively (P = .20 and P = .40).
Extension of embolization to segment IV portal branches should not be routinely used because a similar volume increase of segments II-III can be simply achieved by right PVE.
对于拟行右三叶肝切除术的患者，有人建议常规栓塞IV段并联合右门静脉栓塞（PVE），以诱导II - III段更快、更显著地肥大。我们的目的是比较在接受大肝切除术的患者中，PVE联合或不联合IV段栓塞所诱导的II - III段肥大情况。
对连续26例患者进行前瞻性评估；使用螺旋CT扫描门静脉期图像，分别在右PVE术前及术后3至4周计算未来残余肝体积（R组，n = 13），其中13例患者的栓塞范围扩展至IV段分支（L组）。
20例患者（76.9%）接受了预定的肝切除术。6例未进行计划手术的患者中，5例病情进展；1例（L组）患者因左叶存在栓塞材料，未来残余肝体积增加不足。PVE与体积测量之间的平均±标准差时间为31.8±9.3天。未来残余肝体积总体平均±标准差增加为53.1%±24.8%；IV段的增加在R组显著高于L组。两组II - III段PVE后的平均±标准差体积及体积增加率相似：R组分别为348.4±83.1 cm³和67.8%±30.8%，L组分别为391.2±78.05 cm³和56.1%±35.1%（P = 0.20和P = 0.40）。
不应常规将栓塞扩展至IV段门静脉分支，因为单纯通过右PVE即可使II - III段获得相似的体积增加。
