- 期刊
Factors Affecting Left Lobe Hypertrophy after Right Portal Vein Embolization in Patients with Chronic Liver Disease
慢性肝病患者接受右肝門靜脈栓塞術後可能影響肝臟左葉增生的因素
摘要
背景：不論是外科手術或介入性放射線學治療，右肝門靜脈栓塞(PVE)是未來肝臟剩餘量(FLRV)偏小的慢性肝病患者，於右肝切除之前，使未來剩餘肝臟(FLR)增生的主要方法。本研究之目的是評估慢性肝病患者接受右肝門靜脈栓塞後，使未來剩餘肝臟增生，可能造成影響的臨床和生物化學的參數，如METAVIR纖維化評分。方法：於2007年1月至2014年9月之間，共有813例肝細胞癌(HCC)或膽管癌患者接受肝切除。這些患者中，共20例是未來剩餘肝臟偏小的患者。這些患者於右肝切除之前接受右肝門靜脈栓塞術，且未接受術前化療或肝動脈栓塞治療。結果：評估的參數包括血清中天冬氨酸氨基轉移酶(AST)、丙氨酸基轉移酶(ALT)、鹼性磷酸脢(ALP)、丙麩胺酸轉移酶(GGT)、白蛋白，總膽紅素、甲型胎兒蛋白(AFP)的濃度、凝血酶原時間、Child-Pugh 評分、METAVIR纖維化評分和B型或C型肝炎感染史。參數中只有纖維化程度與未來的功能性肝臟剩餘(% FFLR)體積(p =0.042)的變化有顯著相關。進一步的分析顯示，只有輕微的(F1)和中等(F2) 程度的纖維化，與未來剩餘肝臟的體積增加有顯著相關(p = 0.043；p = 0.028)。結論：肝纖維化的嚴重程度與接受右肝門靜脈栓塞後未來剩餘肝臟體積增生的程度呈負相關。
並列摘要
Background: Right portal vein embolization (PVE), performed either surgically or radiologically, is the main method used to induce growth of the future liver remnant (FLR) before right hemihepatectomy in patients with an insufficient future liver remnant volume (FLRV) due to chronic liver disease. The purpose of this study was to evaluate whether clinical and laboratory variables, as well as METAVIR fibrosis score, are predictive of PVE-induced growth of the FLR in patients with chronic liver disease. Methods: During the period from January 2007 to September 2014, a total of 813 patients underwent hemihepatectomy for hepatocellular carcinoma (HCC) or cholangiocarcinoma. Of those patients, 20 had an inadequate FLR and required right PVE before hemihepatectomy. None of the 20 patients had received preoperative chemotherapy or transarterial chemoembolization. Results: Of the parameters evaluated (serum levels of AST, ALT, ALP, GGT, albumin, total bilirubin, AFP, prothrombin time, Child- Pugh score, METAVIR fibrosis score and history of hepatitis B or hepatitis C infection), only the fibrosis score was associated with a significant change in the estimated rate of functional future liver remnant (%FFLR) volume (p = 0.042). Further analysis revealed that only mild (F1) and moderate (F2) degrees of fibrosis were associated with a significant increase in the FLRV (p = 0.043 and p = 0.028, respectively). Conclusion: The severity of liver fibrosis was found to be negatively correlated with the degree of FLR hypertrophy prior to portal vein embolization.
延伸閱讀
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