Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Paul Brousse Hospital, Villejuif, France,
Département Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France,
Eur Surg Res. 2020;61(2-3):62-71. doi: 10.1159/000509713. Epub 2020 Oct 13.
Portal vein embolization (PVE) is an accepted technique to preoperatively increase the volume of the future remnant liver before major hepatectomy. A permanent material is usually preferred since its superiority to induce liver hypertrophy over absorbable material has been demonstrated. Nevertheless, the use of an absorbable material generates a reversible PVE (RPVE) capable of inducing significant liver hypertrophy. In small animal models, the possibility to proceed to a repeated RPVE (RRPVE) has shown to boost liver hypertrophy further. The aim of this preliminary study was to assess the feasibility and the tolerance of RRPVE in a large animal model, in comparison with permanent PVE (PPVE) and single RPVE.
Six swine (2 per group) were assigned either to single RPVE group (using powdered gelatin sponge), RRPVE group (2 RPVEs separated by 14 days) or PPVE group (using N-butyl-cyanoacrylate). The feasibility and tolerance of the procedures were evaluated using portography, liver function tests and histological analysis. Evolution of liver volumes was assessed with volumetric imaging by computed tomography.
Embolization of portal branches corresponding to 75% of total liver volume was performed successfully in all animals. Procedures were well tolerated, inducing moderate changes in portal pressure and transient aminotransferase increase. None of the animals developed portal vein thrombosis. After RPVE, complete recanalization occurred at day 11. RRPVE showed a trend for higher hypertrophy, the non-embolized liver to total liver ratio reaching 5.2 ± 1.0% in the RPVE group, 6.8 ± 0.1% in the RRPVE group and 5.0 ± 0.3% in the PPVE group.
DISCUSSION/CONCLUSION: In this preliminary comparative study, RRPVE was as feasible and as well tolerated as the other procedures, and resulted in higher liver hypertrophy.
门静脉栓塞术（PVE）是一种在大肝切除术前增加未来剩余肝脏体积的公认技术。通常首选永久性材料，因为已证明其在诱导肝肥大方面优于可吸收材料。然而，可吸收材料的使用会产生可逆转的门静脉栓塞术（RPVE），能够诱导显著的肝肥大。在小动物模型中，重复进行 RPVE（RRPVE）的可能性已被证明可以进一步促进肝肥大。本初步研究的目的是在大动物模型中评估 RRPVE 的可行性和耐受性，与永久性 PVE（PPVE）和单次 RPVE 进行比较。
6 头猪（每组 2 头）分别被分配到单次 RPVE 组（使用粉末状明胶海绵）、RRPVE 组（2 次 RPVEs，间隔 14 天）或 PPVE 组（使用 N-丁基-氰基丙烯酸酯）。使用门静脉造影术、肝功能试验和组织学分析评估程序的可行性和耐受性。通过计算机断层扫描的容积成像评估肝体积的演变。
所有动物均成功地栓塞了对应于总肝体积 75%的门静脉分支。这些程序均耐受良好，仅导致门静脉压力中度升高和短暂的转氨酶升高。没有动物发生门静脉血栓形成。在 RPVE 后，在第 11 天完全再通。RRPVE 显示出更高肥大的趋势，未栓塞的肝与总肝的比值在 RPVE 组达到 5.2±1.0%，RRPVE 组达到 6.8±0.1%，PPVE 组达到 5.0±0.3%。
讨论/结论：在这项初步的比较研究中，RRPVE 与其他程序一样具有可行性且耐受性良好，并且导致更高的肝肥大。
