Liver Transplant Unit & General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
World J Surg. 2012 Jan;36(1):125-8. doi: 10.1007/s00268-011-1331-0.
Postoperative liver failure (PLF) is the most feared and severe complication after extensive liver resections.
We present an innovative surgical technique that has been employed for the treatment of three patients (two with multiple colorectal liver metastases and one with hilar cholangiocarcinoma) whose livers were previously considered locally unresectable because of an insufficient future liver remnant (FLR). In-situ liver transection with right portal vein ligation was implemented.
Six days after surgery a volumetric computed tomography (CT)-scan showed 40-80% hypertrophy of the FLR. The patients then underwent a completion surgery with right hepatectomy or right trisectionectomy. None of the patients developed PLF during a mean hospital stay of 16 days. After a mean follow-up of two months, the three of them are free of disease.
This technique induced rapid growth of the FLR, greater than that reported with portal vein occlusion alone. It represents a promising advance in oncological liver surgery that readdresses the current management of patients with primarily unresectable liver disease. Such a revolutionary strategy allows a two-stage surgical approach during a single hospital stay and without PLF. However, further research is needed to determine the long-term outcomes of this technique and to explain the occurrence of such enhanced liver regeneration.
术后肝衰竭（PLF）是广泛肝切除术后最令人恐惧和严重的并发症。
我们提出了一种创新的手术技术，已用于治疗三例患者（两例为多发性结直肠肝转移，一例为肝门部胆管癌），由于未来肝残留量（FLR）不足，这些患者的肝脏先前被认为无法局部切除。实施了原位肝切开术并结扎右门静脉。
术后 6 天，体积计算机断层扫描（CT）显示 FLR 有 40-80%的增生。然后，这些患者接受了右半肝切除术或右三叶切除术的完成手术。三名患者在平均 16 天的住院期间均未发生 PLF。平均随访两个月后，他们三人都无疾病。
该技术诱导 FLR 快速生长，超过了单独门静脉阻断报道的结果。它代表了肿瘤学肝外科的一项有前途的进展，重新审视了目前对主要不可切除性肝病患者的管理。这种革命性的策略允许在单次住院期间和不发生 PLF 的情况下进行两阶段手术方法。然而，需要进一步的研究来确定该技术的长期结果，并解释这种增强的肝再生的发生。
