Narula Nisha, Aloia Thomas A
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Herman Pressler Drive, Unit 1484, Houston, TX, 77030, USA.
Langenbecks Arch Surg. 2017 Aug;402(5):727-735. doi: 10.1007/s00423-017-1591-8. Epub 2017 May 31.
Liver resection of benign, primary, and metastatic tumors is challenging and places patients at risk of postoperative liver insufficiency. This risk is largely dependent on the volume and function of the future liver remnant (FLR). It is, therefore, critical that hepatobiliary surgeons are well versed in the measurement of liver volume and function, as well as various techniques for preoperative liver volume augmentation.
This comprehensive review of portal vein embolization (PVE) begins with an overview of FLR measurement and progresses to patient factors to consider when choosing PVE and assessment of hypertrophy. PVE techniques and complications are subsequently discussed.
The absolute volume of FLR required to avoid postoperative liver insufficiency is dependent on the patient, disease, and anatomic factors. Rapid expansion of the FLR can be achieved with PVE of contralateral liver segments. Although multiple metrics have been used to correlate hypertrophy with postoperative outcomes after PVE, the kinetic growth rate (KGR) is the most reliable predictor of freedom from postoperative liver insufficiency. PVE is now considered a safe and effective procedure when performed at high-volume hepatobiliary centers. It is an effective tool that, by lowering the risk of liver failure, increases the number of patients who can undergo potential curative hepatectomy.
良性、原发性和转移性肿瘤的肝切除术具有挑战性，会使患者面临术后肝功能不全的风险。这种风险很大程度上取决于未来肝残余量（FLR）的体积和功能。因此，肝胆外科医生精通肝脏体积和功能的测量以及术前肝脏体积增大的各种技术至关重要。
本对门静脉栓塞术（PVE）的全面综述首先概述FLR测量，然后探讨选择PVE时要考虑的患者因素以及肥大评估。随后讨论PVE技术和并发症。
避免术后肝功能不全所需的FLR绝对体积取决于患者、疾病和解剖因素。对侧肝段的PVE可实现FLR的快速增大。尽管已使用多种指标将肥大与PVE后的术后结果相关联，但动力学生长率（KGR）是预测无术后肝功能不全最可靠的指标。在大容量肝胆中心进行PVE时，现在认为它是一种安全有效的手术。它是一种有效的工具，通过降低肝衰竭风险，增加了能够接受潜在根治性肝切除术的患者数量。
