Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Surgery. 2018 May;163(5):1014-1019. doi: 10.1016/j.surg.2017.11.026. Epub 2018 Feb 28.
The factors which affect hypertrophy of the future liver remnant after portal vein embolization remain unclear. The aim of this study was to clarify the clinical factors affecting the hypertrophy rate after portal vein embolization and to develop a scoring system predicting insufficient liver hypertrophy.
The cases of a total of 152 patients who underwent portal vein embolization of the right portal branch between 2006 and 2016 were reviewed retrospectively. The score to predict insufficient (<25%) hypertrophy was established based on logistic regression analyses of the clinical parameters before portal vein embolization.
After portal vein embolization, the future liver remnant volume, expressed as the median (range), significantly increased from 364 (151-801) mL, 33% (18%-54%), to 451 (242-866) mL, 42% (26%-65%). The median hypertrophy rate was 24% (-5% to 96%). A preoperative predictive scoring system for insufficient liver hypertrophy was constructed using the following 3 factors: an initial future liver remnant volume ≥35% (2 points), alkaline phosphatase ≥450 IU/dL (1 point), and cholinesterase <220 mg/dL (1 point). The constructed scoring system indicated the proportion of patients with insufficient liver hypertrophy (<25%) to be 6 out of 42 (14%) in the low-score group (0 points), 44 out of 77 (57%) in the medium-score group (1-2 points), and 30 out of 33 (91%) in the high-score group (3-4 points). The hypertrophy rate of future liver remnant was different among the 3 groups (low-score group, 38.9% [-2.4% to 81.4%]; medium-score group, 22.7% [-5.1% to 95.5%]; high-score group, 18.2% [2.4%-30.7%]) (P < .001).
The constructed scoring system was able to stratify patients before portal vein embolization according to the possibility of developing insufficient liver hypertrophy.
影响门静脉栓塞后剩余肝脏增生的因素尚不清楚。本研究旨在明确影响门静脉栓塞后肝增生率的临床因素，并建立预测肝增生不足（<25%）的评分系统。
回顾性分析 2006 年至 2016 年间行右门静脉分支门静脉栓塞术的 152 例患者的病例。基于门静脉栓塞前临床参数的逻辑回归分析，建立预测肝增生不足（<25%）的评分。
门静脉栓塞后，剩余肝脏体积中位数（范围）从 364（151-801）ml、33%（18%-54%）增加至 451（242-866）ml、42%（26%-65%）。中位数肝增生率为 24%（-5%至 96%）。采用以下 3 个因素构建术前预测肝增生不足的评分系统：初始剩余肝脏体积≥35%（2 分）、碱性磷酸酶≥450IU/dL（1 分）、胆碱酯酶<220mg/dL（1 分）。构建的评分系统显示低评分组（0 分）中有 6 例（14%）、中评分组（1-2 分）中有 44 例（57%）、高评分组（3-4 分）中有 30 例（91%）患者发生肝增生不足（<25%）。3 组患者剩余肝脏的增生率不同（低评分组 38.9%[-2.4%至 81.4%]；中评分组 22.7%[-5.1%至 95.5%]；高评分组 18.2%[2.4%-30.7%]）（P<0.001）。
该评分系统能够在门静脉栓塞前对患者进行分层，预测肝增生不足的可能性。
