Nanashima Atsushi, Tanoue Yukinori, Yano Koichi, Hiyoshi Masahide, Imamura Naoya, Hamada Takeomi, Kai Kengo, Kitamura Eiji, Suzuki Yasuto, Tahira Kousei, Kawano Fumiya, Nagayasu Takeshi
Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, University of Miyazaki Hospital, Kihara Kiyotake, Miyazaki 889-1692, Japan.
Division of Surgical Oncology, Nagasaki University School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Surg Open Sci. 2022 May 28;9:117-124. doi: 10.1016/j.sopen.2022.05.012. eCollection 2022 Jul.
To identify predictors of changes in hepatic volumes after portal vein embolization, we examined the relationship with preoperative nutritional and immunological parameters.
Ninety-three patients who underwent portal vein embolization were included. The control group comprised 13 patients who underwent right hepatectomy without portal vein embolization. Computed tomographic volumetric parameter was measured for changes in embolized and nonembolized liver. Correlation with various candidates of immunonutritional parameters was examined.
Difference in increased liver ratio was 9.1%. C-reactive protein levels significantly increased after portal vein embolization (P < .01), whereas albumin and total cholesterol levels significantly decreased, respectively (P < .01). The C-reactive protein/albumin ratio, prognostic nutritional index, Controlling Nutritional Status score, and modified Glasgow Prognostic Score were significantly different, respectively (P < .01). Prothrombin activity and total cholesterol level significantly correlated with the increased change in nonembolized liver (P < .05). The C-reactive protein and C-reactive protein/albumin ratio after portal vein embolization negatively correlated with hypertrophic ratio (P < .05). By comparing posthepatectomy outcomes between 64 patients undergoing portal vein embolization and 13 who did not, the prevalence of severe complications and mortality in the portal vein embolization group was not different from that in the non-portal vein embolization group. Liver activity at 15 minutes > 0.92 and increased liver volume ≥ 10% tended to correlate with lower prevalence of severe complications. Only increased intraoperative blood loss ≥ 1,500 mL was significantly associated with morbidity and mortality (P < .05).
Contrary to our hypothesis, immunonutritional parameters, except C-reactive protein and C-reactive protein/albumin ratio, did not reflect hypertrophy after portal vein embolization. Although it is difficult to predict the hypertrophic degree, the strategy of scheduled hepatectomy should be switched in case of impaired inflammatory status after portal vein embolization.
为了确定门静脉栓塞术后肝脏体积变化的预测因素，我们研究了其与术前营养和免疫参数的关系。
纳入93例行门静脉栓塞术的患者。对照组包括13例行右肝切除术但未行门静脉栓塞术的患者。通过计算机断层扫描体积参数测量栓塞和未栓塞肝脏的变化。研究了其与各种免疫营养参数候选指标的相关性。
肝脏增大率差异为9.1%。门静脉栓塞术后C反应蛋白水平显著升高（P<0.01），而白蛋白和总胆固醇水平分别显著降低（P<0.01）。C反应蛋白/白蛋白比值、预后营养指数、控制营养状况评分和改良格拉斯哥预后评分分别有显著差异（P<0.01）。凝血酶原活性和总胆固醇水平与未栓塞肝脏的增大变化显著相关（P<0.05）。门静脉栓塞术后的C反应蛋白和C反应蛋白/白蛋白比值与肥大率呈负相关（P<0.05）。通过比较64例行门静脉栓塞术的患者和13例未行门静脉栓塞术的患者的肝切除术后结果，门静脉栓塞组严重并发症的发生率和死亡率与非门静脉栓塞组无差异。15分钟时肝脏活性>0.92且肝脏体积增加≥10%往往与严重并发症的发生率较低相关。仅术中失血增加≥1500 mL与发病率和死亡率显著相关（P<0.05）。
与我们的假设相反，除C反应蛋白和C反应蛋白/白蛋白比值外，免疫营养参数并未反映门静脉栓塞后的肥大情况。尽管难以预测肥大程度，但在门静脉栓塞后炎症状态受损的情况下，应改变预定肝切除术的策略。
