Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Oncology, Viet Duc University Hospital, 40 Trang Thi, Hang Bong, Hoan Kiem, Hanoi, 100000, Vietnam.
Langenbecks Arch Surg. 2021 Aug;406(5):1511-1519. doi: 10.1007/s00423-020-02044-1. Epub 2021 Jan 6.
To evaluate the incidence, risk factors, management options, and outcomes of portal vein thrombosis following major hepatectomy for perihilar cholangiocarcinoma.
A total of 177 perihilar cholangiocarcinoma patients who (1) underwent major hepatectomy and (2) underwent investigating the portal vein morphology, which was measured by rotating the reconstructed three-dimensional images after facilitating bone removal using Aquarius iNtuition workstation between 2002 and 2018, were included. Risk factors were evaluated using the Kaplan-Meier method and Cox proportional hazard models.
Six patients developed portal vein thrombosis (3.4%) within a median time of 6.5 (range 0-22) days. Portal vein and hepatic artery resection were performed in 30% and 6% patients, respectively. A significant difference in the probability of the occurrence of portal vein thrombosis (PV) within 30 days was found among patients with portal vein resection, a postoperative portal vein angle < 100°, remnant portal vein diameter < 5.77 mm, main portal vein diameter > 13.4 mm, and blood loss (log-rank test, p = 0.003, p = 0.06, p < 0.0001, p = 0.01, and p = 0.03, respectively). Decreasing the portal vein angle and narrowing of the remnant PV diameter remained significant predictors on multivariate analysis (p = 0.027 and 0.002, respectively). Reoperation with thrombectomy was performed in four patients, and the other two patients were successfully treated with anticoagulants. All six patients subsequently recovered and were discharged between 25 and 70 days postoperatively.
Narrowing of the remnant portal vein diameter and a decreased portal vein angle after major hepatectomy for perihilar cholangiocarcinoma are significant independent risk factors for postoperative portal vein thrombosis.
评估肝门部胆管癌根治性肝切除术后门静脉血栓形成的发生率、危险因素、处理方法和结局。
共纳入 177 例肝门部胆管癌患者，（1）接受了根治性肝切除手术，（2）进行了门静脉形态学研究。采用 Aquarius iNtuition 工作站去除骨骼后旋转重建的三维图像，在 2002 年至 2018 年间测量门静脉形态。采用 Kaplan-Meier 方法和 Cox 比例风险模型评估危险因素。
中位时间为 6.5（范围 0-22）天内，6 例患者发生门静脉血栓形成（3.4%）。门静脉和肝动脉切除分别在 30%和 6%的患者中进行。术后门静脉角度<100°、残门静脉直径<5.77mm、主门静脉直径>13.4mm 和术中出血量较大的患者，其门静脉血栓形成（PV）在 30 天内发生的概率存在显著差异（对数秩检验，p=0.003、p=0.06、p<0.0001、p=0.01 和 p=0.03）。多因素分析显示，门静脉角度减小和残门静脉直径变窄仍然是显著的预测因素（p=0.027 和 0.002）。4 例患者接受了再次手术取栓治疗，另外 2 例患者成功接受抗凝治疗。所有 6 例患者随后恢复，术后 25-70 天出院。
肝门部胆管癌根治性肝切除术后残门静脉直径变窄和门静脉角度减小是术后门静脉血栓形成的独立危险因素。
