Dhurandhar Vikrant, Waugh Richard, Ahmed Sulman, Mantrala Suchitra, Chaganti Joga
Department of Medical Imaging Nepean Hospital Kingswood New South Wales Australia.
Department of Surgery Nepean Hospital Kingswood New South Wales Australia.
JGH Open. 2021 Jul 10;5(8):941-946. doi: 10.1002/jgh3.12614. eCollection 2021 Aug.
Portal vein embolization (PVE) prior to hepatic resection reduces the risk of hepatic insufficiency in the postoperative period by redistributing blood from the embolized unhealthy liver to the healthy liver, termed the functional liver remnant (FLR). A retrospective analysis of liver volumes after embolization in a single institution was performed to identify change in volume of the FLR and determine factors affecting this change.
Between 2013 and 2015, 21 patients undergoing PVE followed by hepatic resection for varied indications (colorectal metastases, hepatocellular carcinoma, cholangiocarcinoma, etc.) were included in this study. -butyl cyanoacrylate glue diluted with Lipiodol (35-45% strength) along with 75-100 μm of polyvinyl alcohol particles were used for embolization. Liver volumetric determination was performed before and after PVE and volume changes in the FLR were analyzed. Biochemical factors and factors affecting FLR hypertrophy were also analyzed.
Majority of the patients ( = 18) underwent right-lobe embolization. All were performed using the ipsilateral approach. No major complications occurred with only one patient developing post-procedural ascites requiring percutaneous draining. A significant increase in the mean volume of the FLR by 63.7% ± 91.6%, = 0.001 was noted after PVE. The FLR/total liver volume (TLV) increased significantly by 17% ± 18%. No significant demographic factors affected FLR hypertrophy and no significant biochemical changes were noted. Thirteen patients were successfully operated on after embolization.
PVE is effective in inducing significant hypertrophy of the future FLR, prior to hepatic resection in our institution.
肝切除术前进行门静脉栓塞（PVE），可通过将栓塞的不健康肝脏的血液重新分配至健康肝脏（即功能性肝残余（FLR）），降低术后肝衰竭的风险。对某单一机构栓塞后的肝脏体积进行回顾性分析，以确定FLR体积的变化并确定影响该变化的因素。
2013年至2015年期间，本研究纳入了21例接受PVE继而因各种适应证（结直肠癌转移、肝细胞癌、胆管癌等）行肝切除的患者。使用用碘油稀释的氰基丙烯酸丁酯胶（浓度为35 - 45%）以及75 - 100μm的聚乙烯醇颗粒进行栓塞。在PVE前后进行肝脏体积测定，并分析FLR的体积变化。还分析了生化因素和影响FLR肥大的因素。
大多数患者（n = 18）接受了右叶栓塞。均采用同侧入路进行。未发生重大并发症，仅1例患者术后出现腹水，需经皮引流。PVE后，FLR的平均体积显著增加63.7%±91.6%，P = 0.001。FLR/全肝体积（TLV）显著增加17%±18%。未发现显著的人口统计学因素影响FLR肥大，也未观察到显著的生化变化。13例患者栓塞后成功接受手术。
在我们机构，PVE在肝切除术前有效诱导未来FLR显著肥大。
