Mise Yoshihiro, Passot Guillaume, Wang Xuemei, Chen Hsiang-Chun, Wei Steven, Brudvik Kristoffer W, Aloia Thomas A, Conrad Claudius, Huang Steven Y, Vauthey Jean-Nicolas
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
J Gastrointest Surg. 2016 Jul;20(7):1317-23. doi: 10.1007/s11605-016-3145-8. Epub 2016 Apr 12.
Portal vein embolization (PVE) reduces the risks of hepatic insufficiency after major hepatectomy for small predicted liver remnant. The extent of liver hypertrophy after PVE depends on various clinical factors. We sought to develop a nomogram for predicting the increase in the volume of segments 2 and 3 after right PVE (RPVE).
In 360 patients who underwent RPVE from 1998 through 2013, clinicopathologic data were analyzed, including body mass index (BMI), diabetes, aspirin use, viral hepatitis status, preoperative albumin level, total bilirubin level, prothrombin time, platelet count, type of liver neoplasm, preoperative chemotherapy, previous laparotomy or hepatectomy, segment 4 embolization, two-stage hepatectomy, and liver volumes before and after PVE. Multivariate linear regression analysis was used to identify variables predicting the degree of hypertrophy of segments 2 and 3.
Multivariate regression analysis revealed that BMI (p = 0.002), previous hepatectomy (p = 0.03), RPVE in the setting of two-stage hepatectomy (p < 0.001), and segment 4 embolization (p = 0.003) independently predicted the degree of hypertrophy of segments 2 and 3. Based on the fitted model, a nomogram was constructed.
The constructed nomogram predicts the degree of hypertrophy of segments 2 and 3 after RPVE and can be used in clinical decision making for patients undergoing right hepatectomy.
门静脉栓塞术（PVE）可降低因预计肝剩余体积较小而进行大肝切除术后肝衰竭的风险。PVE术后肝脏肥大的程度取决于多种临床因素。我们试图建立一个列线图来预测右门静脉栓塞术（RPVE）后第2和第3肝段体积的增加。
对1998年至2013年接受RPVE的360例患者的临床病理数据进行分析，包括体重指数（BMI）、糖尿病、阿司匹林使用情况、病毒性肝炎状态、术前白蛋白水平、总胆红素水平、凝血酶原时间、血小板计数、肝肿瘤类型、术前化疗、既往剖腹手术或肝切除术、第4肝段栓塞、两阶段肝切除术以及PVE前后的肝脏体积。采用多变量线性回归分析来确定预测第2和第3肝段肥大程度的变量。
多变量回归分析显示，BMI（p = 0.002）、既往肝切除术（p = 0.03）、两阶段肝切除术中的RPVE（p < 0.001）以及第4肝段栓塞（p = 0.003）独立预测了第2和第3肝段的肥大程度。基于拟合模型，构建了一个列线图。
构建的列线图可预测RPVE后第2和第3肝段的肥大程度，并可用于接受右肝切除术患者的临床决策。
