Is embolization of segment 4 portal veins before extended right hepatectomy justified?

Is embolization of segment 4 portal veins before extended right hepatectomy justified?
复制标题

DOI：
10.1016/j.surg.2008.05.015
复制
发表时间：
2008-11-01
期刊：
SURGERY
影响因子：
3.8
通讯作者：
Vauthey, Jean-Nicolas
Vauthey, Jean-Nicolas
中科院分区：
医学2区
文献类型：
--
作者：
Kishi, Yoji;Madoff, David C.;Vauthey, Jean-Nicolas

文献摘要

被引文献

相似文献

背景资料。门静脉栓塞术(PVE)越来越多地被用来为残肝体积或功能不足的患者进行大范围肝切除术的准备。然而，是否应该对4段(S4)门静脉进行栓塞术仍存在争议。观察S4PVE对节段2、3(S2+3)体积增大的影响。对73例正常肝患者行右门静脉栓塞术(RPVE，n=15)和扩大至S4门静脉栓塞术(RPVE+4，n=58)，比较栓塞术后S2+3和S4的体积变化。评估临床结果和PVE并发症。中位数27天后，RPVE和RPVE+4组S2+3体积均显著增加，但绝对值增加更明显(中位数106mLvs141mL；P=.044)，肥厚率(中位数26%vs54%；P=.021)。RPVE+4组和RPVE+4组在S4绝对容积增加量(RPVE+4组为55ml，RPVE+4组为52ml；P=.61)或S4肥厚率(RPVE组为30%，RPVE+4组为26%；P=.45)方面无显著差异。RPVE术后并发症1例(7%)，RPVE+4术后6例(10%)(P&gt；99)。没有PVE并发症排除了随后的切除。RPVE后根治性肝切除13例(87%)，RPVE+4后根治性肝切除40例(69%)(P=.21)。与单纯RPVE相比，RPVE+4可显著改善S2+3肥厚。将RPVE延长至S4不会增加PVE相关并发症。(外科2008，-144：744-51。)
Background. Preoperative portal vein embolization (PVE) is increasingly used as a preparation for major hepatectomy in patients with inadequate liver remnant volume or function. However, whether segment 4 (S4) portal veins should be embolized is controversial. The effect of S4 PVE on the volume gain of segments 2 and 3 (S2+3) was examined.Methods. Among 73 patients with uninjured liver who underwent right portal vein embolization (RPVE, n=15) or RPVE extended to S4 portal veins (RPVE+4, n=58), volume changes in S2+3 and S4 after embolization were compared. Clinical outcomes and PVE complications were assessed.Results. After a median of 27 days, the S2+3 volume increased significantly after both RPVE and RPVE+4, but the absolute increase was significantly, higher for RPVE+4 (median, 106 mL vs 141 mL; P=.044), as was the hypertrophy rate (median, 26% vs 54%; P=.021). There was no significant difference between RPVE,: and RPVE+4 in the absolute S4 volume increase (52 mL for RPVE vs 55 ml for RPVE+4; P=.61) or the hypertrophy rate of S4 (30% for RPVE vs 26% for RPVE+4; P=.45). Complications of PVE occurred in 1 patient (7%) after RPVE and 6 (10%) after RPVE+4 (P>.99). No PVE complication precluded subsequent resection. Curative hepatectomy was performed in 13 patients (87%) after RPVE and 40 (69%) after RPVE+4 (P =.21).Conclusions. RPVE+4 significantly improves S2+3 hypertrophy compared with RPVE alone. Extending RPVE to S4 does not increase PVE-associated complications. (Surgery 2008,-144:744-51.)