Department of Surgery, Moinhos de Vento Hospital, Porto Alegre, Brazil; University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil; Oncological Center of Ana Nery Hospital and Saint Gallen Institute of Oncology, Santa Cruz do Sul, Brazil.
Department of Surgery, Moinhos de Vento Hospital, Porto Alegre, Brazil; University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.
Eur J Surg Oncol. 2014 Feb;40(2):140-3. doi: 10.1016/j.ejso.2013.08.012. Epub 2013 Aug 28.
Stimulation of hepatic hypertrophy is a useful aid to accomplish hepatic resections when the future liver remnant (FLR) is small. Although inflow occlusion, especially through portal flow, has been extensively studied, the role of outflow modulation has not yet been described.
Description of outflow modulation to tailor hypertrophy of future liver remnant in the context of bilobar metastatic disease. A patient with small FLR (segments I and IV) was managed with a two-stage procedure. The first stage consisted of a right hepatectomy and modulation of the left hepatic vein outflow through reduction of its diameter, with macroscopic congestion of segments II-III. The second stage consisted of a left lateral sectionectomy six weeks later. Postoperative courses were uneventful without any sign of liver failure.
Following the first stage procedure computed tomography revealed distinct hypertrophy rates between sections. The non-congested area had an increase of 156% in the volume of segment IV (from 137 to 351 cm(3)) and 100% in the volume of segment I (from 20 to 40 cm(3)). The congested area, segments II-III, increased only 24% (from 205 to 253 cm(3)).
Modulation of liver outflow allows maintenance of function in the segments to be resected while avoiding their hypertrophy. This process prevents liver failure and optimizes regeneration of hepatic territories to be preserved.
刺激肝肥大是完成肝切除的有用辅助手段，尤其是当剩余肝体积（FLR）较小时。尽管已经广泛研究了入肝血流阻断，特别是门静脉血流阻断，但流出道调节的作用尚未描述。
在两叶转移性疾病的背景下，描述了流出道调节以适应剩余肝体积的肥大。一名患者的 FLR 较小（I 段和 IV 段），采用两阶段手术治疗。第一阶段为右半肝切除术，并通过减小左肝静脉流出道的直径来调节其血流，从而导致 II-III 段肉眼可见淤血。第二阶段为六周后行左外叶切除术。术后过程顺利，无肝功能衰竭迹象。
第一阶段手术后 CT 显示各段之间存在明显的肥大率。非淤血区 IV 段体积增加了 156%（从 137cm³增加到 351cm³），I 段体积增加了 100%（从 20cm³增加到 40cm³）。淤血区 II-III 段仅增加了 24%（从 205cm³增加到 253cm³）。
肝流出道的调节可以在保持待切除区域功能的同时避免其肥大。这一过程可防止肝功能衰竭，并优化待保留肝区的再生。
