Department of General, Visceral and Transplant Surgery, LMU Klinikum, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany.
Department of Radiology, LMU Klinikum, Munich, Germany.
Langenbecks Arch Surg. 2022 Sep;407(6):2393-2397. doi: 10.1007/s00423-022-02581-x. Epub 2022 Jun 8.
Posthepatectomy liver failure (PHLF) remains a leading cause of death after extensive liver resection. Apart from the size and function of the remaining liver remnant, the development of postresection portal hypertension (pHT) plays a crucial role in the development of PHLF. We hypothesize that the umbilical vein in the preserved round ligament (RL) may recanalize in response to new-onset pHT after extended hepatectomy, thus providing a natural portosystemic shunt.
In this exploratory study, RL was preserved in 10 consecutive patients undergoing major liver resection. Postoperative imaging was pursued to obtain evidence of reopened umbilical vein in the RL. The postoperative course, including the occurrence of PHLF, as well as the rate of procedure-specific complications were recorded.
None of the 10 cases presented with an adverse event due to preservation of the RL. In 6 cases, postoperative imaging demonstrated reopening of the umbilical vein with hepatofugal flow in the RL. The rates of procedure-related surgical complications were lower than would be expected in this population; in particular, the rate of occurrence of PHLF as defined by the International Study Group of Liver Surgery (ISGLS) was low.
Our results support the theoretical concept of portosystemic pressure relief via a preserved umbilical vein after major liver surgery. As preservation of the RL is easily done, we suggest keeping it intact in extended hepatectomy cases and in patients with preexistent pHT.
广泛肝切除术后肝衰竭（PHLF）仍然是导致死亡的主要原因。除了剩余肝实质的大小和功能外，术后门静脉高压症（pHT）的发展在 PHLF 的发展中起着至关重要的作用。我们假设，在扩大肝切除术后，由于新发的 pHT，保留的圆韧带（RL）中的脐静脉可能再通，从而提供自然的门体分流。
在这项探索性研究中，在连续 10 例接受大肝切除术的患者中保留 RL。进行术后影像学检查以获得 RL 中重新开放的脐静脉的证据。记录术后过程，包括 PHLF 的发生，以及特定于程序的并发症的发生率。
RL 保留的 10 例患者均未发生与 RL 保留相关的不良事件。在 6 例病例中，术后影像学显示 RL 中脐静脉重新开放且血流向肝。与该人群中预期的相比，与程序相关的手术并发症的发生率较低；特别是，国际肝脏外科研究组（ISGLS）定义的 PHLF 发生率较低。
我们的结果支持在大型肝手术后通过保留的脐静脉缓解门体压力的理论概念。由于 RL 的保留很容易做到，我们建议在扩大肝切除术病例和存在预发性 pHT 的患者中保持 RL 完整。
