Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
Liver Transpl. 2018 Jul;24(7):881-887. doi: 10.1002/lt.25024. Epub 2018 Apr 6.
The goal of the study is to characterize the relationship between portal vein thrombosis (PVT) and hepatic atrophy in patients without cirrhosis and the effect of various types of surgical shunts on liver regeneration and splenomegaly. Patients without cirrhosis with PVT suffer from presinusoidal portal hypertension, and often hepatic atrophy is a topic that has received little attention. We hypothesized that patients with PVT have decreased liver volumes, and shunts that preserve intrahepatic portal flow enhance liver regeneration. Sixty-four adult and pediatric patients with PVT who underwent surgical shunt placement between 1998 and 2011 were included in a retrospective study. Baseline liver volumes from adult patients were compared with standard liver volume (SLV) as well as a group of healthy controls undergoing evaluation for liver donation. Clinical assessment, liver function tests, and liver and spleen volumes from cross-sectional imaging were compared before and after surgery. A total of 40 patients received portal flow-preserving shunts (32 mesoportal and 8 selective splenorenal), whereas 24 received portal flow-diverting shunts (16 nonselective splenorenal and 8 mesocaval). Baseline adult liver volumes were 26% smaller than SLV (1248 versus 1624 cm ; P = 0.02) and 20% smaller than the control volumes (1248 versus 1552 cm ; P = 0.02). Baseline adult spleen volumes were larger compared with controls (1258 versus 229 cm ; P < 0.001). Preserving shunts were associated with significant increase in liver volumes (886 versus 1131 cm ; P = 0.01), whereas diverting shunts were not. Diverting shunts significantly improved splenomegaly. In conclusion, we have demonstrated that patients without cirrhosis with PVT have significant liver atrophy and splenomegaly. Significant liver regeneration was achieved after portal flow-preserving shunts. Liver Transplantation 24 881-887 2018 AASLD.
本研究的目的是描述非肝硬化患者门静脉血栓形成（PVT）与肝萎缩之间的关系，以及各种类型的外科分流术对肝脏再生和脾肿大的影响。患有 PVT 的非肝硬化患者患有窦前性门静脉高压，而肝萎缩通常是一个关注较少的话题。我们假设 PVT 患者的肝体积减少，保留肝内门脉血流的分流术可增强肝脏再生。本回顾性研究纳入了 1998 年至 2011 年间接受外科分流术的 64 例成人和儿童 PVT 患者。将成人患者的基线肝体积与标准肝体积（SLV）以及一组接受肝捐赠评估的健康对照组进行比较。比较手术前后的临床评估、肝功能检查以及肝脏和脾脏的横断面影像学体积。共有 40 例患者接受了保留门脉血流的分流术（32 例中门-门静脉，8 例选择性脾肾），而 24 例患者接受了分流术（16 例非选择性脾肾，8 例中门-腔静脉）。成人患者的基线肝体积比 SLV 小 26%（1248 与 1624cm ³ ；P = 0.02），比对照组小 20%（1248 与 1552cm ³ ；P = 0.02）。基线成人脾脏体积大于对照组（1258 与 229cm ³ ；P < 0.001）。保留分流术与肝体积显著增加相关（886 与 1131cm ³ ；P = 0.01），而分流术则没有。分流术显著改善了脾肿大。总之，我们已经证明，患有 PVT 的非肝硬化患者存在明显的肝萎缩和脾肿大。保留门脉血流的分流术后可实现显著的肝脏再生。肝移植 24 881-887 2018 AASLD。
