In situ liver transection with portal vein ligation for rapid growth of the future liver remnant in two-stage liver resection
In situ liver transection with portal vein ligation for rapid growth of the future liver remnant in two-stage liver resection
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DOI：
10.1002/bjs.8955
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发表时间：
2013-02-01
影响因子：
9.6
通讯作者：
Topp, S. A.
中科院分区：
文献类型：
--
作者：
Knoefel, W. T.;Gabor, I.;Topp, S. A.
背景资料：门静脉栓塞（PVE）已成为增加未来肝脏残留（FLR）并使最初无法切除的肝脏肿瘤得以根治性切除的标准手术。本研究探讨了一种新的两阶段肝切除技术的安全性和可行性，该技术在完成肝切除术前使用原位肝横断（ISLT）和门静脉结扎。研究方法：将2009年至2011年间接受ISLT和扩大右半肝切除术的连续患者系列与PVE后接受扩大右半肝切除术的连续患者进行比较。由于FLR不足（肝段II/III），所有患者最初均患有不可切除的原发性或继发性肝肿瘤。结果：对15例PVE患者和7例在扩大右半肝切除术前接受ISLT的患者进行了评价。ISLT在3天内诱导FLR快速生长，特别是在PVE不足后，从平均（s.d.）293（58）ml至477（85）ml，相当于体积增加63%（29%）。所有接受ISLT的患者均在8天内（范围48天）完成了扩大的右半肝切除术。结论：ISLT是一种有效可靠的技术，可诱导FLR快速生长，即使在PVE后容量增加不足的患者中也是如此。版权所有（c）2012英国外科学会杂志有限公司由约翰威利父子有限公司出版。
Background: Portal vein embolization (PVE) has become a standard procedure to increase the future liver remnant (FLR) and enable curative resection of initially unresectable liver tumours. This study investigated the safety and feasibility of a new two-stage liver resection technique that uses in situ liver transection (ISLT) and portal vein ligation before completion hepatectomy. Methods: A consecutive series of patients undergoing ISLT and extended right hepatectomy between 2009 and 2011 were compared with consecutive patients undergoing extended right hepatectomy after PVE. All patients had initially unresectable primary or secondary liver tumours, owing to an insufficient FLR (liver segments II/III). Results: Fifteen patients who had PVE and seven who underwent ISLT before extended right hepatectomy were evaluated. ISLT induced rapid growth of the FLR within 3 days, particularly after insufficient PVE, from a mean(s.d.) of 293(58) ml to 477(85) ml, corresponding to a volume increase of 63(29) per cent. All patients who had ISLT underwent completion extended right hepatectomy within 8 days (range 48 days). Conclusion: ISLT is an effective and reliable technique to induce rapid growth of the FLR, even in patients with insufficient volume increase after PVE. Copyright (c) 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.