肝脏分隔及门静脉右支结扎术后肝内门静脉侧支血管开放与肝组织增生关联分析

Association Between Intrahepatic Portoportal Venous Collateral Vascular Formation and Postoperative Liver Hyperplasia in Patients with Liver Partition and Portal Vein Ligation

【目的】探讨肝实质分隔和门静脉右支结扎术后肝内门静脉侧支血管开放对残余肝组织增生水平的影响。【方法】回顾性分析2013年4月至2022年6月在中山大学附属第一医院行肝实质分隔和门静脉右支结扎术的肝细胞癌患者的临床资料。根据患者一期术后肝内门静脉开放侧支血管的数量分为3组:未开放组,开放血管1条组和开放血管≥2条组。首先分析3组在术前、术中及术后肝功能、肝组织增生情况、二期手术情况等方面的分布差异,进一步采用多重线性回归分析探讨影响一期术后肝内门静脉开放侧支血管数量不同的因素。【结果】合计37例实施了肝实质分隔和门静脉右支结扎术肝癌患者最终纳入本研究。3组术前情况差异均无统计学意义(P>0.05)。3组患者肝实质分隔方式存在差异,采用微波消融分隔肝实质法的患者开放血管≥2条的比例大于肝实质离断法的患者(57.14%vs.42.56%,P=0.031),而3组在手术时间、失血量、输血量水平等指标的差异均无统计学意义(P>0.05)。3组患者每日残余肝组织增长体积[侧支血管≥2 vs.侧支血管=1 vs.侧支血管=0,(14.25±8.81 vs.20.65±9.85 vs.30.10±19.31)mL;P=0.018],差异有统计学意义。3组行二期切除者的比例无差异(P=0.363),但侧支血管开放≥2条者手术间隔天数显著长于未开放或只开放1条者[(16.31±5.44 vs.10.30±3.40 vs.12.78±3.35)d;P=0.023]。采用多重线性回归分析,逐步法纳入性别、年龄、术前肝功能分级、门静脉高压、肿瘤数目等相关因素,结果发现肝实质分隔方式是唯一影响肝内门静脉侧支血管开放数目的因素(P=0.031),微波消融和肝脏离断分隔肝实质后形成的肝内门静脉侧支血管数目分别为[2.0(1.5)vs.1.0(1.0)条,P=0.031]。【结论】肝实质分隔及门静脉右支结扎术后肝内门静脉侧支血管开放数目与肝组织增生水平负相关,采用肝实质离断分隔肝实质形成的侧支血管数目较少。

【Objective】To investigate the association between intrahepatic portoportal venous collateral vascular for-mation and postoperative liver hyperplasia in patients undergoing liver partition and portal vein ligation.【Methods】The clinical data of patients with hepatocellular carcinoma who underwent liver partition and portal vein ligation at the Center of Hepato-Pancreatico-Biliary Surgery in the First Affiliated Hospital of Sun Yat-sen University from April 2013 to June 2022 were retrospectively analyzed.All the patients were grouped according to the number of open collateral vessels in the liver after first-stage surgery,including the group with no formation of intrahepatic portoportal venous collateral vessel(IPCs=0),the group with 1 formation of intrahepatic portoportal venous collateral vessel(IPCs=1),and the group with more than 2 formations of intrahepatic portoportal venous collateral vessels(IPCs≥2).The differences in the distribution of the three groups in terms of preoperative,intraoperative and postoperative liver function,formation of intrahepatic porto-portal venous collateral vessels on both sides,and second-stage surgery were analyzed firstly,and then multiple linear re-gression analysis was used to explore the factors affecting the number of IPCs.【Results】Of all the 37 patients with hepato-cellular carcinoma who were finally included in this study,there were no significant differences in preoperative data be-tween the three groups(P>0.05).The surgical procedure was different between the three groups.The proportion of patients with≥2 open vessels who underwent laparoscopic microwave ablation liver partition was greater than that of patients with split liver(57.14%vs.42.56%,P=0.031).There was a statistically significant difference in the daily hypertrophy volume of future liver remnant(FLR)[IPCs≥2 vs.IPCs=1 vs.IPCs=0,(14.25±8.81 vs.20.65±9.85 vs.30.10±19.31)mL,P=0.018].There was no difference in the proportion of patients between the three groups who underwent second-stage resec-tion(P=0.363).However,the number of days between surgeries was significantly longer in those with≥2 open collateral vessels than in those with no opening or only 1 opening(16.31±5.44 vs.10.30±3.40 vs.12.78±3.35)days,P=0.023.Multi-ple linear regression analysis found that the surgical procedure was the only factor affecting the number of intrahepatic col-lateral vessel openings(P=0.031).The number of IPCs after laparoscopic microwave ablation liver partition and split liver was[2.0(1.5)vs.1.0(1.0),P=0.031].【Conclusions】The number of IPCs after liver partition and portal vein right branch ligation is negatively associated with the hypertrophy rate of FLR and split of liver is recommended to reduce the formation of IPCs.