Rassam Fadi, Uz Zühre, van Lienden Krijn P, Ince Can, Bennink Roelof J, van Gulik Thomas M
Departments of Surgery.
Translational Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Nucl Med Commun. 2019 Jul;40(7):720-726. doi: 10.1097/MNM.0000000000001012.
Hepatobiliary scintigraphy using technetium-99m mebrofenin has been validated as a quantitative liver function test. Preoperative portal vein embolization (PVE) is performed in patients to increase future remnant liver function and volume. Changes in hepatic microcirculation after PVE remain largely unknown and may influence the uptake of mebrofenin. The aim was to evaluate microcirculatory changes after PVE to examine differences in perfusion that might influence the uptake of mebrofenin, and consequently, assessment of function.
Patients undergoing liver resection with or without preoperative PVE were included. Future remnant liver volume and function were measured before and after PVE. Hepatic microcirculation was measured in the embolized and the nonembolized lobes during resection. Microcirculatory flow index, perfused vessel density, sinusoidal diameter and red blood cell velocity were assessed.
A total of 16 patients, eight with preoperative PVE and eight control patients without PVE, were included. After PVE, both function and volume of the nonembolized lobe were significantly increased, and the functional increase exceeded the increase in volume. Perfused vessel density and sinusoidal diameter were significantly higher in the nonembolized liver lobe (P<0.002 and <0.04). No significant differences between both lobes were found concerning microcirculatory flow index or red blood cell velocity.
After PVE, the nonembolized lobe had a significantly higher (functional) microvascular density compared with the embolized lobe, without differences in microvascular flow. These findings indicate that the measured functional increase using hepatobiliary scintigraphy, which exceeded the volumetric increase, was not the consequence of an increase in hepatic perfusion, therefore, providing adequate representation of the liver function.
使用锝-99m 美布芬宁的肝胆闪烁显像已被确认为一种定量肝功能检查方法。对患者进行术前门静脉栓塞（PVE）以增加未来残余肝功能和体积。PVE 后肝微循环的变化在很大程度上尚不清楚，可能会影响美布芬宁的摄取。本研究旨在评估 PVE 后的微循环变化，以检查可能影响美布芬宁摄取进而影响功能评估的灌注差异。
纳入接受肝切除术且有或无术前 PVE 的患者。在 PVE 前后测量未来残余肝体积和功能。在切除过程中测量栓塞和未栓塞肝叶的肝微循环。评估微循环血流指数、灌注血管密度、肝血窦直径和红细胞速度。
共纳入 16 例患者，其中 8 例接受术前 PVE，8 例为未接受 PVE 的对照患者。PVE 后，未栓塞肝叶的功能和体积均显著增加，且功能增加超过体积增加。未栓塞肝叶的灌注血管密度和肝血窦直径显著更高（P<0.002 和<0.04）。在微循环血流指数或红细胞速度方面，两个肝叶之间未发现显著差异。
PVE 后，与栓塞肝叶相比，未栓塞肝叶的（功能性）微血管密度显著更高，而微血管血流无差异。这些发现表明，使用肝胆闪烁显像测量的功能增加超过了体积增加，并非肝灌注增加的结果，因此能够充分反映肝功能。
