Department of Surgery, Meiwa Hospital 4-31 Agenaruo-cho, Nisinomiya, Hyogo 663-8186, Japan.
World J Gastroenterol. 2012 May 21;18(19):2371-6. doi: 10.3748/wjg.v18.i19.2371.
To compare the effect of percutaneous transhepatic portal vein embolization (PTPE) and unilateral portal vein ligation (PVL) on hepatic hemodynamics and right hepatic lobe (RHL) atrophy.
Between March 2005 and March 2009, 13 cases were selected for PTPE (n = 9) and PVL (n = 4) in the RHL. The PTPE group included hilar bile duct carcinoma (n = 2), intrahepatic cholangiocarcinoma (n = 2), hepatocellular carcinoma (n = 2) and liver metastasis (n = 3). The PVL group included hepatocellular carcinoma (n = 2) and liver metastasis (n = 2). In addition, observation of postoperative hepatic hemodynamics obtained from computed tomography and Doppler ultrasonography was compared between the two groups.
Mean ages in the two groups were 58.9 ± 2.9 years (PVL group) vs 69.7 ± 3.2 years (PTPE group), which was a significant difference (P = 0.0002). Among the indicators of liver function, including serum albumin, serum bilirubin, aspartate aminotransferase, alanine aminotransferase, platelets and indocyanine green retention rate at 15 min, no significant differences were observed between the two groups. Preoperative RHL volumes in the PTPE and PVL groups were estimated to be 804.9 ± 181.1 mL and 813.3 ± 129.7 mL, respectively, with volume rates of 68.9% ± 2.8% and 69.2% ± 4.2%, respectively. There were no significant differences in RHL volumes (P = 0.83) and RHL volume rates (P = 0.94), respectively. At 1 mo after PTPE or PVL, postoperative RHL volumes in the PTPE and PVL groups were estimated to be 638.4 ± 153.6 mL and 749.8 ± 121.9 mL, respectively, with no significant difference (P = 0.14). Postoperative RHL volume rates in the PTPE and PVL groups were estimated to be 54.6% ± 4.2% and 63.7% ± 3.9%, respectively, which was a significant difference (P = 0.0056). At 1 mo after the operation, the liver volume atrophy rate was 14.3% ± 2.3% in the PTPE group and 5.4% ± 1.6% in the PVL group, which was a significant difference (P = 0.0061).
PTPE is a more effective procedure than PVL because PTPE is able to occlude completely the portal branch throughout the right peripheral vein.
比较经皮经肝门静脉栓塞术（PTPE）和单侧门静脉结扎术（PVL）对肝血流动力学和右肝叶（RHL）萎缩的影响。
2005 年 3 月至 2009 年 3 月，我们选择了 13 例 RHL 行 PTPE（n=9）和 PVL（n=4）。PTPE 组包括肝门胆管癌（n=2）、肝内胆管细胞癌（n=2）、肝细胞癌（n=2）和肝转移瘤（n=3）。PVL 组包括肝细胞癌（n=2）和肝转移瘤（n=2）。此外，比较了两组术后 CT 和多普勒超声检查获得的肝血流动力学观察结果。
两组的平均年龄分别为 58.9±2.9 岁（PVL 组）和 69.7±3.2 岁（PTPE 组），差异有统计学意义（P=0.0002）。在肝功能指标方面，包括血清白蛋白、血清胆红素、天冬氨酸转氨酶、丙氨酸转氨酶、血小板和吲哚菁绿 15 分钟潴留率，两组间无显著差异。PTPE 和 PVL 组术前 RHL 体积估计分别为 804.9±181.1 mL 和 813.3±129.7 mL，体积率分别为 68.9%±2.8%和 69.2%±4.2%，RHL 体积（P=0.83）和 RHL 体积率（P=0.94）无显著差异。PTPE 或 PVL 术后 1 个月，PTPE 和 PVL 组的术后 RHL 体积估计分别为 638.4±153.6 mL 和 749.8±121.9 mL，无显著差异（P=0.14）。PTPE 和 PVL 组术后 RHL 体积率估计分别为 54.6%±4.2%和 63.7%±3.9%，差异有统计学意义（P=0.0056）。术后 1 个月，PTPE 组肝萎缩率为 14.3%±2.3%，PVL 组为 5.4%±1.6%，差异有统计学意义（P=0.0061）。
PTPE 比 PVL 更有效，因为 PTPE 能够完全闭塞右外周静脉的门静脉分支。
