Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
World J Surg. 2012 Dec;36(12):2901-8. doi: 10.1007/s00268-012-1770-2.
Preoperative portal vein embolization (PVE) is used to increase the future remnant liver (FRL) in patients requiring extensive liver resection. Computed tomography (CT) volumetry, performed not earlier than 3-6 weeks after PVE, is commonly employed to assess hypertrophy of the FRL following PVE. Early parameters to predict effective hypertrophy are therefore desirable. The aim of the present study was to assess plasma bile salt levels, triglycerides (TG), and apoA-V in the prediction of the hypertrophy response during liver regeneration.
Serum bile salt, TG, and apoA-V levels were determined in 20 patients with colorectal metastases before PVE, and 5 h, 1, and 21 days after PVE, as well as prior to and after (day 1-7, and day 21) subsequent liver resection. These parameters were correlated with liver volume as measured by CT volumetry (%FRL-V), and liver function was determined by technetium-labeled mebrofenin hepatobiliary scintigraphy using single photon emission computed tomography.
Triglyceride levels at baseline correlate with volume increase of the future remnant liver (FRL-V) post-PVE. Also, bile salts and TG 5 h after PVE positively correlated with the increase in FRL volume (r=0.672, p=0.024; r=0.620, p=0.042, resp.) and liver function after 3 weeks (for bile salts r=0.640, p=0.046). Following liver surgery, TG levels at 5 h and 1 day after resection were associated with liver remnant volume after 3 months (r=0.921, p=0.026 and r=0.981, p=0.019, resp). Plasma apoA-V was increased during liver regeneration.
Bile salt and TG levels at 5 h after PVE/resection are significant early predictors of liver volume and functional increase. It is suggested that these parameters can be used for early timing of volume assessment and resection after PVE.
术前门静脉栓塞术（PVE）用于增加需要广泛肝切除术的患者的未来剩余肝脏（FRL）。在 PVE 后 3-6 周进行的计算机断层扫描（CT）体积测量常用于评估 PVE 后 FRL 的肥大。因此，需要早期预测有效肥大的参数。本研究旨在评估血浆胆汁盐水平、甘油三酯（TG）和载脂蛋白 A-V 在预测肝再生期间肥大反应中的作用。
在 PVE 前、PVE 后 5 小时、1 天和 21 天以及随后的肝切除前和切除后（第 1-7 天和第 21 天），检测 20 例结直肠癌转移患者的血清胆汁盐、TG 和载脂蛋白 A-V 水平。这些参数与 CT 体积测量（%FRL-V）测量的肝体积相关，并用锝标记美罗芬酸肝胆闪烁扫描术通过单光子发射计算机断层扫描法测定肝功能。
基线时的甘油三酯水平与 PVE 后未来剩余肝脏（FRL-V）的体积增加相关。此外，PVE 后 5 小时的胆汁盐和 TG 与 FRL 体积的增加呈正相关（r=0.672，p=0.024；r=0.620，p=0.042，分别），与 3 周后的肝功能呈正相关（r=0.640，p=0.046）。肝切除术后，切除后 5 小时和 1 天的 TG 水平与 3 个月后的肝残余体积相关（r=0.921，p=0.026 和 r=0.981，p=0.019，分别）。在肝再生期间，血浆载脂蛋白 A-V 增加。
PVE/切除后 5 小时的胆汁盐和 TG 水平是肝体积和功能增加的重要早期预测指标。建议这些参数可用于 PVE 后早期评估体积和切除时间。
