Department of Surgery, Uppsala University, 75185 Uppsala, Sweden.
HPB (Oxford). 2013 Apr;15(4):265-72. doi: 10.1111/j.1477-2574.2012.00540.x. Epub 2012 Aug 20.
Sinusoidal injury (SI) after oxaliplatin-based therapies for colorectal liver metastasis (CRLM) can increase postoperative morbidity. Preoperative methods to estimate SI are lacking. The aim of this study was to identify SI by evaluating portal vein haemodynamics.
Magnetic resonance imaging flowmetry (MRIF) was used to estimate portal vein haemodynamics in 29 patients with CRLM before liver surgery. Sinusoidal injury was evaluated from resected non-tumorous liver parenchyma according to the combined vascular injury (CVI) score of ≥3.
All patients with SI (six of 29) received oxaliplatin; however, a significant association could not be proven (P= 0.148). Oxaliplatin-treated patients showed portal vein dilatation in both the SI and non-SI groups compared with patients who had not received oxaliplatin (Bonferroni corrected P= 0.003 and P= 0.039, respectively). Mean portal velocity tended to be lower in patients with SI compared with oxaliplatin-treated patients without SI (Bonferroni corrected P= 0.087). A mean portal velocity of ≤14.35 cm/s together with a cross-section area of ≥1.55 cm(2) was found to predict SI with sensitivity of 100% and specificity of 78%.
Oxaliplatin treatment was associated with portal vein dilatation. Patients with SI showed a tendency towards decreased mean portal flow velocity. This may indicate that SI is associated with an increased resistance to blood flow in the liver parenchyma. Portal vein haemodynamic variables estimated by MRIF can identify patients without SI non-invasively.
奥沙利铂为基础的结直肠癌肝转移（CRLM）治疗后的窦状隙损伤（SI）会增加术后发病率。目前缺乏用于评估 SI 的术前方法。本研究旨在通过评估门静脉血流动力学来识别 SI。
使用磁共振成像流量测定法（MRIF）对 29 例 CRLM 肝切除术患者术前的门静脉血流动力学进行评估。根据≥3 分的联合血管损伤（CVI）评分，从切除的非肿瘤性肝实质中评估 SI。
所有患有 SI（29 例中的 6 例）的患者均接受奥沙利铂治疗；然而，未证明两者之间存在显著相关性（P=0.148）。与未接受奥沙利铂治疗的患者相比，奥沙利铂治疗患者的 SI 和非 SI 组门静脉均扩张（经 Bonferroni 校正，P=0.003 和 P=0.039）。与无 SI 的奥沙利铂治疗患者相比，SI 患者的平均门静脉速度趋于较低（经 Bonferroni 校正，P=0.087）。发现平均门静脉速度≤14.35 cm/s 时，伴有横截面积≥1.55 cm²可预测 SI，其灵敏度为 100%，特异性为 78%。
奥沙利铂治疗与门静脉扩张有关。SI 患者的平均门静脉血流速度呈下降趋势。这可能表明 SI 与肝实质血流阻力增加有关。MRIF 估计的门静脉血流动力学变量可无创性识别无 SI 的患者。
