Malinowski Maciej, Geisel Dominik, Stary Victoria, Denecke Timm, Seehofer Daniel, Jara Maximillian, Baron Annekathrin, Pratschke Johann, Gebauer Bernhard, Stockmann Martin
Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Berlin, Germany.
J Surg Res. 2015 Mar;194(1):202-11. doi: 10.1016/j.jss.2014.10.028. Epub 2014 Oct 30.
Portal vein embolization (PVE) has become the standard of care before extended hepatectomy. Various PVE methods using different embolization materials have been described. In this study, we compared PVE with polyvinyl alcohol particles alone (PVA only) versus PVA with plug or coils (PVA + plug/coils).
Patients undergoing PVE before hepatectomy were included. PVA alone was used until December 2013, thereafter plug or coils were placed in addition. The volume of left lateral liver lobe (LLL), clinical parameters, and liver function tests were measured before PVE and resection.
A total of 43 patients were recruited into the PVA only group and 42 were recruited into the PVA + plug/coils group. There were no major differences between groups except significantly higher total bilirubin level before PVE in the PVA only group, which improved before hepatectomy. Mean LLL volume increased by 25.7% after PVE in the PVA only group and by 44% in the PVA + plug/coils group (P < 0.001). Recanalization was significantly less common in the PVA + plug/coils group. In multivariate regression, initial LLL volume and use of plug or coils were the only parameters influencing LLL volume increase. The postoperative liver failure rate was significantly reduced in PVA + plug/coils group (P = <0.001).
PVE using PVA particles together with plug or coils is a safe and efficient method to increase future liver remnant volume. The additional central embolization with plug or coils led to an increased hypertrophy, due to lower recanalization rates, and subsequently decreased incidence of postoperative liver failure. No additional procedure-specific complications were observed in this series.
门静脉栓塞术（PVE）已成为扩大肝切除术前的标准治疗方法。已描述了使用不同栓塞材料的各种PVE方法。在本研究中，我们比较了单纯使用聚乙烯醇颗粒（仅PVA）的PVE与使用栓塞栓子或弹簧圈（PVA +栓塞栓子/弹簧圈）的PVE。
纳入肝切除术前接受PVE的患者。2013年12月之前仅使用PVA，此后额外放置栓塞栓子或弹簧圈。在PVE和切除术前测量左外侧肝叶（LLL）体积、临床参数和肝功能检查。
仅PVA组共纳入43例患者，PVA +栓塞栓子/弹簧圈组纳入42例患者。除仅PVA组PVE前总胆红素水平显著较高外，两组之间无重大差异，该指标在肝切除术前有所改善。仅PVA组PVE后LLL平均体积增加25.7%，PVA +栓塞栓子/弹簧圈组增加44%（P < 0.001）。PVA +栓塞栓子/弹簧圈组再通明显较少见。在多因素回归分析中，初始LLL体积以及栓塞栓子或弹簧圈的使用是影响LLL体积增加的唯一参数。PVA +栓塞栓子/弹簧圈组术后肝衰竭发生率显著降低（P = <0.001）。
使用PVA颗粒联合栓塞栓子或弹簧圈的PVE是增加未来肝剩余体积的一种安全有效的方法。由于再通率较低，额外使用栓塞栓子或弹簧圈进行中央栓塞导致肥大增加，随后降低了术后肝衰竭的发生率。本系列未观察到额外的特定手术并发症。
