Transplant and Hepatobiliopancreatic Surgery Unit, Department of General and Digestive Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
J Gastrointest Surg. 2020 Jun;24(6):1386-1391. doi: 10.1007/s11605-020-04576-9. Epub 2020 Apr 20.
The "Small-for-Size" syndrome is defined as a liver failure after a liver transplant with a reduced graft or after a major hepatectomy. The later coined "Small-for-Flow" syndrome describes the same situation in liver resections but based on hemodynamic intraoperative parameters (portal pressure > 20 mmHg and/or portal flow > 250 ml/min/100 g). This focuses on the damage caused by the portal hyperafflux related to the volume of the remnant.
Relevant studies were reviewed using Medline, PubMed, and Springer databases.
Portal hypertension after partial hepatectomies also leads to a higher morbidity and mortality. There are plenty of experimental studies focusing on flow rather than size. Some of them also perform different techniques to modulate the portal inflow. The deleterious effect of high posthepatectomy portal venous pressure is known, and that is why the idea of portal flow modulation during major hepatectomies in humans is increasing in everyday clinical practice.
Considering the extensive knowledge obtained with the experimental models and good results in clinical studies that analyze the "Small-for-Flow" syndrome, we believe that measuring portal flow and portal pressure during major liver resections should be performed routinely in extended liver resections. Applying these techniques, the knowledge of hepatic hemodynamics would be improved in order to advance against posthepatectomy liver failure.
“小肝综合征”是指肝移植后供肝体积减小或肝切除后发生肝衰竭。后来提出的“小流量综合征”描述了肝切除术中同样的情况，但基于术中血流动力学参数（门静脉压>20mmHg 和/或门静脉流量>250ml/min/100g）。这主要关注与剩余肝体积相关的门静脉高流量引起的损伤。
使用 Medline、PubMed 和 Springer 数据库对相关研究进行了回顾。
部分肝切除术后也会导致更高的发病率和死亡率。有大量的实验研究关注流量而不是体积。其中一些研究还采用了不同的技术来调节门静脉流入。人们已经了解到肝切除术后门静脉高压的有害影响，这就是为什么在人类的大型肝切除术中越来越多地考虑在门静脉血流调节的想法。
考虑到从实验模型中获得的广泛知识以及分析“小流量综合征”的临床研究中的良好结果，我们认为在扩大的肝切除术中，应常规测量主要肝切除术中的门静脉流量和门静脉压力。应用这些技术可以提高对肝血流动力学的了解，以防止肝切除术后肝衰竭。
