Venous reconstruction based on virtual liver resection to avoid congestion in the liver remnant
Venous reconstruction based on virtual liver resection to avoid congestion in the liver remnant
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DOI：
10.1002/bjs.7670
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发表时间：
2011-12-01
影响因子：
9.6
通讯作者：
Kokudo, N.
中科院分区：
文献类型：
--
作者：
Mise, Y.;Hasegawa, K.;Kokudo, N.
背景：肝静脉（HV）重建可以防止侵犯主要HV的肝肿瘤切除后的静脉充血。本研究的目的是确定标准静脉重建的基础上，术前评估静脉congestion.Methods：体积分析，使用图像处理软件进行了选择的患者与肝脏肿瘤怀疑术前成像的主要HV入侵。通过从肝脏残余物中减去充血面积来计算非充血肝脏残余物（NND）的大小。对于符合以下标准的患者，安排静脉重建：肝功能正常（15分钟时吲哚菁绿绿色留存率（ICGR（15））小于10%），NCLR小于肝脏总体积（TLV）的40%，或肝功能障碍（ICGR 15 10- 20%），NCLR小于TLV的50%。结果：共纳入55例疑似HV侵犯的患者。在37例患者中，认为可能处死一个或多个HV。18例患者计划进行静脉重建。手术时，11例患者未见静脉受累。29例患者的HV被处死，24例患者的HV被保留或重建。3个月时，牺牲组（88%）和保存组（87%）的体积恢复率相似。结论：根据建议的标准可以安全地处死HV，减少手术创伤，不影响术后进程。
Background: Hepatic vein (HV) reconstruction may prevent venous congestion following resection of liver tumours that encroach on major HVs. This study aimed to identify criteria for venous reconstruction based on preoperative evaluation of venous congestion.Methods: A volumetric analysis using image-processing software was performed in selected patients with liver tumours suspected on preoperative imaging of major HV invasion. The size of the non-congested liver remnant (NCLR) was calculated by subtracting the congested area from the liver remnant. Venous reconstruction was scheduled in patients who met the following criteria: normal liver function (indocyanine green retention rate at 15 min (ICGR(15)) of less than 10 per cent) with a NCLR smaller than 40 per cent of total liver volume (TLV), or liver dysfunction (ICGR15 10-20 per cent) with a NCLR smaller than 50 per cent of TLV. Surgical outcomes and liver regeneration were investigated.Results: A total of 55 patients with suspected HV invasion were enrolled. Sacrifice of one or more HVs was deemed possible in 37 patients. Venous reconstruction was scheduled in 18 patients. At operation, there was seen to be no venous involvement in 11 patients. The HV was sacrificed in 29 patients, and preserved or reconstructed in 24. Volume restoration ratios at 3 months were similar in the sacrifice (88 per cent) and preserve (87 per cent) groups. Operating time was shorter (465 min) and blood loss was lower (580 ml) in the sacrifice than in the preserve group (523 min and 815 ml respectively).Conclusion: The HV can be sacrificed safely according to the proposed criteria, reducing surgical invasiveness without influencing the postoperative course.