van den Esschert Jacomina W, de Graaf Wilmar, van Lienden Krijn P, Busch Olivier R, Heger Michal, van Delden Otto M, Gouma Dirk J, Bennink Roelof J, Laméris Johan S, van Gulik Thomas M
Department of Surgery, Academic Medical Center, IWO-1, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
J Gastrointest Surg. 2009 Aug;13(8):1464-9. doi: 10.1007/s11605-009-0929-0. Epub 2009 May 28.
Portal vein embolization is an accepted method to increase the future remnant liver preoperatively. The aim of this study was to assess the effect of preoperative portal vein embolization on liver volume and function 3 months after major liver resection.
This is a retrospective case-control study. Data were collected of patients who underwent portal vein embolization prior to (extended) right hemihepatectomy and of control patients who underwent the same type of resection without prior portal vein embolization. Liver volumes were measured by computed tomography volumetry before portal vein embolization, before liver resection, and 3 months after liver resection. Liver function was assessed by hepatobiliary scintigraphy before and 3 months after liver resection.
Ten patients were included in the embolization group and 13 in the control group. Groups were comparable for gender, age, and number of patients with a compromised liver. The mean future remnant liver volume was 33.0 +/- 8.0% prior to portal vein embolization in the embolization group and 45.6 +/- 9.1% in the control group (p < 0.01). Prior to surgery, there were no significant differences in future remnant liver volume and function between the groups. Three months postoperatively, the mean remnant liver volume was 81.9 +/- 8.9% of the initial total liver volume in the embolization group and 79.4 +/- 11.0% in the control group (p > 0.05). Remnant liver function increased up to 88.1 +/- 17.4% and 83.3 +/- 14% respectively of the original total liver function (p > 0.05).
Preoperative portal vein embolization does not negatively influence postoperative liver regeneration assessed 3 months after major liver resection.
门静脉栓塞术是一种被认可的术前增加未来残余肝脏体积的方法。本研究的目的是评估术前门静脉栓塞术对大肝切除术后3个月肝脏体积和功能的影响。
这是一项回顾性病例对照研究。收集了在（扩大）右半肝切除术前接受门静脉栓塞术的患者以及未接受术前门静脉栓塞术而接受相同类型切除术的对照患者的数据。通过计算机断层扫描容积测量法在门静脉栓塞术前、肝切除术前以及肝切除术后3个月测量肝脏体积。通过肝胆闪烁显像术在肝切除术前和术后3个月评估肝功能。
栓塞组纳入10例患者，对照组纳入例患者。两组在性别、年龄和肝脏功能受损患者数量方面具有可比性。栓塞组门静脉栓塞术前未来残余肝脏体积的平均值为33.0±8.0%，对照组为±9.1%（p<0.01）。手术前，两组之间未来残余肝脏体积和功能无显著差异。术后3个月，栓塞组残余肝脏体积的平均值为初始全肝体积的81.9±8.9%，对照组为79.4±11.0%（p>0.05）。残余肝功能分别增加至原始全肝功能的88.1±17.4%和83.3±14%（p>0.05）。
术前门静脉栓塞术对大肝切除术后3个月评估的术后肝脏再生没有负面影响。
