Orcutt Sonia T, Kobayashi Katsuhiro, Sultenfuss Mark, Hailey Brian S, Sparks Anthony, Satpathy Bighnesh, Anaya Daniel A
Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA.
Diagnostic and Therapeutic Care Line, Section of Radiology, Michael E. DeBakey VA Medical Center, Baylor College of Medicine , Houston, TX , USA.
Front Surg. 2016 Mar 11;3:14. doi: 10.3389/fsurg.2016.00014. eCollection 2016.
Preoperative portal vein embolization (PVE) is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other's techniques to be able to create the optimal plan for each individual patient. Knowledge of the segmental anatomy of the liver is paramount to fully understand the liver segments that need to be embolized and resected. Understanding the portal vein anatomy and the branching variations, along with the techniques used to transect the portal vein during hepatic resection, is important because these variables can affect the PVE procedure and the eventual surgical resection. Comprehension of the advantages and disadvantages of approaches to the portal venous system and the various embolic materials used for PVE is essential to best tailor the procedures for each patient and to avoid complications. Before PVE, meticulous assessment of the portal vein branching anatomy is performed with cross-sectional imaging, and embolization strategies are developed based on the patient's anatomy. The PVE procedure consists of several technical steps, and knowledge of these technical tips, potential complications, and how to avoid the complications in each step is of great importance for safe and successful PVE and ultimately successful hepatectomy. Because PVE is used as an adjunct to planned hepatic resection, priority must always be placed on safety, without compromising the integrity of the future liver remnant, and close collaboration between interventional radiologists and hepatobiliary surgeons is essential to achieve successful outcomes.
术前门静脉栓塞术（PVE）用于扩大肝大部切除术的适应证范围，已成为大型肝胆中心治疗特定肝恶性肿瘤患者的标准治疗方法。迄今为止，使用了各种技术及不同的栓塞材料，在肝脏肥大程度方面取得了相似的结果。无论采用何种具体策略，外科医生和介入放射科医生都必须熟悉彼此的技术，以便为每个患者制定最佳方案。了解肝脏的节段性解剖结构对于全面理解需要栓塞和切除的肝段至关重要。了解门静脉解剖结构及其分支变异，以及肝切除术中横断门静脉所使用的技术也很重要，因为这些变量会影响PVE手术及最终的手术切除。理解门静脉系统入路的优缺点以及用于PVE的各种栓塞材料，对于为每个患者量身定制最佳手术方案并避免并发症至关重要。在进行PVE之前，通过横断面成像对门静脉分支解剖结构进行细致评估，并根据患者的解剖结构制定栓塞策略。PVE手术包括几个技术步骤，了解这些技术要点、潜在并发症以及如何在每个步骤中避免并发症，对于安全、成功地进行PVE以及最终成功实施肝切除术至关重要。由于PVE用作计划肝切除的辅助手段，必须始终将安全放在首位，同时不损害未来肝剩余部分的完整性，介入放射科医生与肝胆外科医生之间的密切合作对于取得成功的结果至关重要。
