Abulkhir Adel, Limongelli Paolo, Healey Andrew J, Damrah Osama, Tait Paul, Jackson James, Habib Nagy, Jiao Long R
HPB Surgery, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College of Science, Technology and Medicine, Hammersmith Hospital Campus, Du Cane Road, London, England.
Ann Surg. 2008 Jan;247(1):49-57. doi: 10.1097/SLA.0b013e31815f6e5b.
Preoperative portal vein embolization (PVE) is used clinically to prevent postoperative liver insufficiency. The current study examined the impact of portal vein embolization on liver resection.
A comprehensive Medline search to identify all registered literature in the English language on portal vein embolization. Meta-analysis was performed to assess the result of PVE and its impact on major liver resection.
A total of 75 publications met the search criteria but only 37 provided data sufficiently enough for analysis involving 1088 patients. The overall morbidity rate for PVE was 2.2% without mortality. Four weeks following PVE, 85% patients underwent the planned hepatectomy (n = 930). Twenty-three patients had transient liver failure following resection after PVE (2.5%) but 7 patients developed acute liver failure and died (0.8%). The reason for nonresection following PVE (n = 158, 15%) included inadequate hypertrophy of remnant liver (n = 18), severe progression of liver metastasis (n = 43), extrahepatic spread (n = 35), refusal to surgery (n = 1), poor general condition (n = 1), altered treatment to transcatheter artery embolization or chemotherapy (n = 24), complete remission after treatment with 3 cycles of fluoracil and interferon alpha in a patient with hepatocellular carcinoma (n = 1), incomplete pre- or postembolization scanning (n = 8). Of those who underwent laparotomy without resection, (n = 27) reasons included intraoperative finding of peritoneal dissemination (n = 15), portal node metastasis (n = 2), severe invasion of the tumor to the hepatic artery and portal vein (n = 1), and gross tumoral extension precluding curative resection (n = 9). Two techniques were used for portal vein embolization: percutaneous transhepatic portal embolization, (PTPE) and transileocolic portal embolization, (TIPE). The increase in remnant liver volume was much greater in PTPE than TIPE group (11.9% vs. 9.7%; P = 0.00001). However, the proportion of patients who underwent resection following PVE was 97% in TIPE and 88% PTPE, respectively (P = <0.00001). Although there was no significant difference in patients who had major complications post-PVE, the rate for minor complications was significantly higher among patients who had PTPE (53.6% vs. 0%, P = <0.0001).
PVE is a safe and effective procedure in inducing liver hypertrophy to prevent postresection liver failure due to insufficient liver remnant.
术前门静脉栓塞术（PVE）在临床上用于预防术后肝功能不全。本研究探讨了门静脉栓塞对肝切除术的影响。
全面检索Medline，以识别所有关于门静脉栓塞的英文注册文献。进行荟萃分析以评估PVE的结果及其对肝大部切除术的影响。
共有75篇出版物符合检索标准，但只有37篇提供了足够的数据用于分析，涉及1088例患者。PVE的总体发病率为2.2%，无死亡病例。PVE后四周，85%的患者接受了计划的肝切除术（n = 930）。23例患者在PVE后肝切除术后出现短暂性肝衰竭（2.5%），但7例患者发生急性肝衰竭并死亡（0.8%）。PVE后未进行肝切除的原因（n = 158，15%）包括残余肝肥大不足（n = 18）、肝转移严重进展（n = 43）、肝外扩散（n = 35）、拒绝手术（n = 1）、一般状况差（n = 1）、改为经导管动脉栓塞或化疗（n = 24）、一名肝细胞癌患者在接受3个周期氟尿嘧啶和α干扰素治疗后完全缓解（n = 1）、栓塞前或栓塞后扫描不完整（n = 8）。在未进行肝切除而接受剖腹手术的患者中（n = 27），原因包括术中发现腹膜播散（n = 15）、门静脉淋巴结转移（n = 2）、肿瘤严重侵犯肝动脉和门静脉（n = 1）以及肿瘤广泛扩展无法进行根治性切除（n = 9）。两种技术用于门静脉栓塞：经皮经肝门静脉栓塞（PTPE）和经回结肠门静脉栓塞（TIPE）。PTPE组残余肝体积的增加比TIPE组大得多（11.9%对9.7%；P = 0.00001）。然而，PVE后接受肝切除的患者比例在TIPE组和PTPE组分别为97%和88%（P = <0.00001）。虽然PVE后发生主要并发症的患者无显著差异，但PTPE患者的轻微并发症发生率显著更高（53.6%对0%，P = <0.0001）。
PVE是一种安全有效的手术，可诱导肝肥大，预防因残余肝不足导致的肝切除术后肝功能衰竭。
