Clinic of Radiology, University Hospital Muenster, Muenster, Germany.
Department for General, Visceral and Transplantation Surgery, University Hospital Muenster, Muenster, Germany.
Z Gastroenterol. 2021 Jan;59(1):35-42. doi: 10.1055/a-1330-9450. Epub 2021 Jan 11.
To analyze safety and effectiveness of simultaneous portal and hepatic vein embolization (PHVE) or sequential hepatic vein embolization (HVE) compared to portal vein embolization (PVE) for future remnant liver (FRL) hypertrophy prior to major hepatic surgery.
Patients undergoing PVE, PHVE or HVE at our tertiary care center between 2018 and 2020 were retrospectively included. FRLV, standardized FRLV (sFRLV) and sFRLV growth rate per day were assessed via volumetry, as well as laboratory parameters.
36 patients (f = 15, m = 21; median 64.5 y) were included, 16 patients received PHVE and 20 patients PVE, of which 4 received sequential HVE. Significant increase of FRLV was achieved with both PVE and PHVE compared to baseline (p < 0.0001). sFRLV growth rate did not significantly differ following PHVE (2.2 ± 1.2 %/d) or PVE (2.2 ± 1.7 %/d, p = 0.94). Left portal vein thrombosis (LPVT) was observed after PHVE in 6 patients and in 1 patient after PVE. Sequential HVE showed a considerably high growth rate of 1.42 ± 0.45 %/d after PVE.
PHVE effectively induces FRL hypertrophy but yields comparable sFRLV to PVE. Sequential HVE further induces hypertrophy after insufficient growth due to PVE. Considering a potentially higher rate of LPVT after PHVE, PVE might be preferred in patients with moderate baseline sFRLV, with optional sequential HVE in non-sufficient responders.
分析在大型肝脏手术前，门静脉栓塞术（PVE）同期或序贯肝静脉栓塞术（HVE）与单纯门静脉栓塞术（PVE）相比，对未来剩余肝脏（FRL）增生的安全性和有效性。
回顾性纳入 2018 年至 2020 年在我们的三级医疗中心接受 PVE、PHVE 或 HVE 的患者。通过体积测量评估 FRLV、标准化 FRLV（sFRLV）和 sFRLV 日增长率，并评估实验室参数。
共纳入 36 例患者（女性 15 例，男性 21 例；中位年龄 64.5 岁），16 例患者接受 PHVE，20 例患者接受 PVE，其中 4 例患者接受序贯 HVE。与基线相比，PVE 和 PHVE 均显著增加了 FRLV（p<0.0001）。PHVE（2.2±1.2%/d）或 PVE（2.2±1.7%/d，p=0.94）后 sFRLV 生长率无显著差异。PHVE 后 6 例患者出现左门静脉血栓形成（LPVT），PVE 后 1 例患者出现 LPVT。PVE 后序贯 HVE 的生长率为 1.42±0.45%/d，相当高。
PHVE 能有效诱导 FRL 增生，但与 PVE 相比，sFRLV 无显著差异。由于 PVE 后生长不足，序贯 HVE 进一步诱导增生。考虑到 PHVE 后 LPVT 的发生率可能较高，对于基线 sFRLV 中度的患者，可能首选 PVE，对非应答者可选序贯 HVE。
