[1]万俊呈,周永杰,余彩虹,等.门静脉栓塞术的临床应用及研究进展[J].介入放射学杂志,2025,34(05):538-543.[doi:10.3969/j.issn.1008-794X.2025.05.017]
 WAN Juncheng,ZHOU Yongjie,YU Caihong,et al.Clinical application and research progress of portal vein embolization[J].J Intervent Med,2025,34(05):538-543.[doi:10.3969/j.issn.1008-794X.2025.05.017]
点击复制

门静脉栓塞术的临床应用及研究进展()

PDF下载中关闭

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
34
期数:
2025年05
页码:
538-543
栏目:
综述
出版日期:
2025-05-25

文章信息/Info

Title:
Clinical application and research progress of portal vein embolization
文章编号:
1008-794X(2025)-005-0538-06
作者:
万俊呈 周永杰 余彩虹 金超俏 周逸柔 瞿旭东
200032 上海复旦大学附属中山医院介入治疗科,国家放射与治疗临床研究中心,上海市影像医学研究所
Author(s):
WAN JunchengZHOU YongjieYU CaihongJIN ChaoqiaoZHOU YirouQU Xudong.
Department of Interventional Radiology,Affiliated Zhongshan Hospital of Fudan University; National Clinical Research Center for Radiation and Therapy; Shanghai Institution of Medical Imaging,Shanghai 200032,China
关键词:
肝脏肿瘤 门静脉栓塞术 剩余肝脏体积 肝切除术 切除后肝功能衰竭
分类号:
R735.7
DOI:
10.3969/j.issn.1008-794X.2025.05.017
文献标志码:
A
摘要:
手术切除是治疗肝癌的重要方法,术后残肝体积不足导致的肝衰竭是制约手术切除成功率的关键因素。门静脉栓塞术(portal vein embolization,PVE)通过栓塞门静脉以人为诱导肝脏体积增大,为避免患者术后因肝衰竭而导致的死亡提供了理论支持。近年来,针对PVE的局限性,尤其是术后肝脏增长率不足等问题,国内外专家在该领域进行了多项创新。因此,该文通过总结PVE相关文献,综述了其临床应用及研究进展。

参考文献/References:

[1] Tong YF,Meng N,Chen MQ,et al.Maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model[J].World J Gastroenterol,2018,24:1107-1119.
[2]韩亚庆,丁宁宁,周 丽,等.CTA与DSA评估慢性肢体威胁性缺血患者全球肢体解剖学分期系统分期的一致性分析[J].介入放射学杂志,2024,33:300-303.
[3]宋晓科,李星悦,张 志,等.ALPPS与门静脉栓塞治疗未来剩余肝脏体积不足肝癌临床疗效的Meta分析[J].现代肿瘤医学,2022,30:3340-3346.
[4]倪俊声,李 曜,葛乃建,等.ALPPS与采用不同栓塞材料PVE对肝再生及手术切除率影响研究[J].中国实用外科杂志,2021,41:1043-1048,1055.
[5]中华人民共和国国家卫生健康委员会医政司.原发性肝癌诊疗指南(2024年版)[J].中华肝脏病杂志,2024,32:581-630.
[6]Kinoshita H,Sakai K,Hirohashi K,et al.Preoperative portal vein embolization for hepatocellular carcinoma[J].World J Surg,1986,10:803-808.
[7]Schnitzbauer A,Lang S,Goessmann H,et al.Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J].Ann Surg,2012,255:405-414.
[8]洪德飞,刘合春,彭淑牖,等.联合肝脏离断和门静脉结扎二步肝切除术治疗肝硬化肝癌疗效分析(附1例报告)[J].中国实用外科杂志,2014:739-743.
[9]Kito Y,Nagino M,Nimura Y.Doppler sonography of hepatic arterial blood flow velocity after percutaneous transhepatic portal vein embolization[J].AJR Am J Roentgenol,2001,176:909-912.
[10]Shimada R,Imamura H,Nakayama A,et al.Changes in blood flow and function of the liver after right portal vein embolization[J].Arch Surg,2002,137:1384-1388.
[11]Kawai M,Naruse K,Komatsu S,et al.Mechanical stress-dependent secretion of interleukin 6 by endothelial cells after portal vein embolization:clinical and experimental studies[J].J Hepatol,2002,37:240-246.
[12]Kusaka K,Imamura H,Tomiya T,et al.Expression of transforming growth factor-alpha and-beta in hepatic lobes after hemihepatic portal vein embolization[J].Dig Dis Sci,2006,51:1404-1412.
[13]Hayashi H,Beppu T,Sugita H,et al.Serum HGF and TGF-beta1 levels after right portal vein embolization[J].Hepatol Res,2010,40:311-317.
[14]Uemura T,Miyazaki M,Hirai R,et al.Different expression of positive and negative regulators of hepatocyte growth in growing and shrinking hepatic lobes after portal vein branch ligation in rats[J].Int J Mol Med,2000,5:173-179.
[15]章世海,储 建,杭化莲,等.80%门静脉结扎后肝脏组织中MMP-9的表达与肝再生作用的相关性研究[J].现代生物医学进展,2011,11:1834-1837.
[16]代雪梅,李可洲,姚豫桐,等.极限门静脉结扎后增生肝脏组织中NF-κB和IL-6表达变化的实验研究[J].重庆医科大学学报,2009,34:1366-1370.
[17]姚豫桐,李可洲,吴晓玲,等.转化生长因子α和β1在极限门静脉结扎肝脏组织中的表达及其意义[J].中国普外基础与临床杂志,2010,17:719-724.
[18]Riddiough GE,Jalal Q,Perini M,et al.Liver regeneration and liver metastasis[J].Semin Cancer Biol,2021,71:86-97.
[19]Zou RH,Li AH,Han F,et al.Liver hypertrophy and accelerated growth of implanted tumors in nonembolized liver of rabbit after left portal vein embolization[J].J Surg Res,2012,178:255-263.
[20]Wilms C,Mueller L,Lenk C,et al.Comparative study of portal vein embolization versus portal vein ligation for induction of hypertrophy of the future liver remnant using a mini-pig model[J].Ann Surg,2008,247:825-834.
[21]Tanaka K,Matsuo K,Murakami T,et al.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS):short-term outcome,functional changes in the future liver remnant,and tumor growth activity[J].Eur J Surg Oncol,2015,41:506-512.
[22]Dhar DK,Mohammad GH,Vyas S,et al.A novel rat model of liver regeneration:possible role of cytokine induced neutrophil chemoattractant-1 in augmented liver regeneration[J].Ann Surg Innov Res,2015,9:11.
[23]Roy BL,Dupre A,Gallon A,et al.Liver hypertrophy:underlying mechanisms and promoting procedures before major hepatectomy[J].J Visc Surg,2018,155:393-401.
[24]Quenet F,Carrere S,Sgarbura O.Contribution of intraperitoneal chemotherapy in the treatment of colorectal peritoneal carcinoma.HIPEC,PIPAC,state of the art and future directions[J].Bulletin du Cancer,2024,111:285-290.
[25]Wu B,Huang X,Ren Z,et al.Comparing iodized oil with polyvinyl alcohol for portal vein embolization in promoting liver remnant increase before partial hepatectomy[J].Asian J Surg,2024,47:874-879.
[26]Cevik E,Albadawi H,Zhang Z,et al.Catheter-directed ionic liquid embolic agent for rapid portal vein embolization,segmentectomy,and bile duct ablation[J].Adv Mater,2024,36:e2402570.
[27]彭淑牖,黄从云,李江涛,等.末梢门静脉栓塞术在计划性肝切除术中的应用初探[J].中华外科杂志,2016,54:664-668.
[28]彭淑牖,黄从云,王许安,等.末梢门静脉栓塞联合肝肿瘤动脉化疗栓塞13例报告[J].中华外科杂志,2017,55:655-660.
[29]彭淑牖,黄从云,王许安,等.末梢门静脉栓塞技术在余肝体积不足肝细胞癌中的应用价值[J].中华外科杂志,2021,59:829-835.
[30]Balzan SM,Gava VG,Magalhaes MA,et al.Outflow modulation to target liver regeneration:something old,something new[J].Eur J Surg Oncol,2014,40:140-143.
[31]Le Roy B,Gagniee J,Chabrot P,et al.Non-lethal right liver atrophy after TIPS occlusion in a cirrhotic patient:introducing the hepatic biembolization[J].J Gastrointest Surg,2016,20:1671-1672.
[32]Munene G,Parker RD,Larrigan J,et al.Sequential preoperative hepatic vein embolization after portal vein embolization for extended left hepatectomy in colorectal liver metastases[J].World J Surg Oncol,2013,11:134.
[33]王晓颖,瞿旭东,许剑民,等.肝静脉-门静脉联合栓塞术促进预留肝脏快速增生——结直肠癌肝转移转化切除新策略[J].中国实用外科杂志,2022,42:672-679.
[34]Guiu B,Chevallier P,Denys A,et al.Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy:the liver venous deprivation technique[J].Eur Radiol,2016,26:4259-4267.
[35]Laurent C,Fernandez B,Marichez A,et al.Radiological simultaneous portohepatic vein embolization(RASPE)before major hepatectomy:a better way to optimize liver hypertrophy compared to portal vein embolization[J].Ann Surg,2020,272:199-205.
[36]王明宇,梁英健,尹 兵,等.肝静脉剥夺术——残余肝脏不足时手术新思路[J].中国实用外科杂志,2020,40:102-105.
[37]Heil J,Korenblik R,Heid F,et al.Preoperative portal vein or portal and hepatic vein embolization:DRAGON collaborative group analysis[J].Br J Surg,2021,108:834-842.
[38]刘 畅,张晓赟,金 谌,等.肝静脉系统栓堵术在第二阶段根治性肝癌切除术中的应用[J].中国普外基础与临床杂志,2019,26:841-846.
[39]Guiu B,Quenet F,Escal L,et al.Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function[J].Eur Radiol,2017,27:3343-3352.
[40]Korenblik R,Heil J,Smits J,et al.Liver regeneration after portal and hepatic vein embolization improves overall survival compared with portal vein embolization alone:mid-term survival analysis of the multicentre DRAGON 0 cohort[J].Br J Surg,2024,111:znae087.
[41]Gaillard M,Hornez E,Lecuelle B,et al.Liver regeneration and recanalization time course following repeated reversible portal vein embolization in swine[J].Eur Surg Res,2020,61:62-71.
[42]Lainas P,Boudechiche L,Osorio A,et al.Liver regeneration and recanalization time course following reversible portal vein embolization[J].J Hepatol,2008,49:354-362.
[43]Tranchart H,Catherine L,Maitre S,et al.Efficient liver regeneration following temporary portal vein embolization with absorbable gelatin sponge powder in humans[J].J Vasc Interv Radiol,2015,26:507-515.
[44]Ribero D,Abdalla EK,Madoff DC,et al.Portal vein embolization before major hepatectomy and its effects on regeneration,resectability and outcome[J].Br J Surg,2007,94:1386-1394.
[45]张 雯,周永杰,颜志平.再论精细TACE[J].介入放射学杂志,2021,30:971-975.
[46]Sun JH,Zhang YL,Nie CH,et al.Effects of liver cirrhosis on portal vein embolization prior to right hepatectomy in patients with primary liver cancer[J].Oncol Lett,2018,15:1411-1416.
[47]李 韧,李江伟,张 澍,等.右半肝切除术前序贯肝动脉-门静脉栓塞治疗肝癌的临床价值[J].现代消化及介入诊疗,2018,23:602-605.
[48]倪俊声,李 曜,刘 学,等.PVE或PVE联合TACE对肝细胞癌二期手术及预后的影响[J].中华消化外科杂志,2024,23:257-264.
[49]吕慧瑶.对比门静脉栓塞与其联合经皮微波消融肝实质分隔促剩余肝增生的临床研究[D].杭州:杭州师范大学,2021.
[50]张远标,洪德飞,黄东胜,等.经皮微波或射频消融肝实质分隔联合门静脉栓塞计划性肝切除术治疗肝硬化肝癌[J].中华消化外科杂志,2016,15:510-514.
[51]成 剑,张远标,范小明,等.经皮微波消融肝实质分隔联合门静脉栓塞治疗肝硬化晚期肝癌的补救性治疗策略探讨[J].中华普通外科杂志,2020,35:77-79.
[52]洪德飞,范小明,罗祖炎,等.经皮微波或射频消融肝实质分隔联合门静脉栓塞计划性肝切除术治疗余肝体积不足肝癌及胆管癌3例报告[J].中国实用外科杂志,2016,36:96-101.
[53]Knapen R,Korenblik R,James S,et al.The effect of microwave and radiofrequency ablation(MWA/RFA)on liver volume in patients with primary and secondary liver tumours:a retrospective analysis[J].Cardiovasc Intervent Radiol,2023,46:991-999.
[54]Garlipp B,de Baere T,Damm R,et al.Left-liver hypertrophy after therapeutic right-liver radioembolization is substantial but less than after portal vein embolization[J].Hepatology,2014,59:1864-1873.
[55]Bekki Y,Marti J,Toshima T,et al.A comparative study of portal vein embolization versus radiation lobectomy with Yttrium-90 micropheres in preparation for liver resection for initially unresectable hepatocellular carcinoma[J].Surgery,2021,169:1044-1051.
[56]Addeo P,de Mathelin P,De Marini P,et al.Sequential Y(90)liver radioembolization and portal vein embolization:an additional strategy to downstage liver tumors and to enhance liver hypertrophy before major hepatectomies[J].Langenbecks Arch Surg,2023,408:339.
[57]黄 剑,张小锋,闫少磊,等.肝门部胆管癌门静脉栓塞后剩余肝脏体积增生速度预测因素分析[J].介入放射学杂志,2023,32:970-974.
[58]Heil J,Heid F,Bechstein WO,et al.Sarcopenia predicts reduced liver growth and reduced resectability in patients undergoing portal vein embolization before liver resection:a DRAGON collaborative analysis of 306 patients[J].HPB(Oxford),2022,24:413-421.
[59]Arntz P,Olthof PB,Korenblik R,et al.Effect of sarcopenia on the increase in liver volume and function after portal vein embolization[J].Cardiovasc Intervent Radiol,2024,47:642-649.
[60]Barcena A,Owens TC,Melancon S,et al.Current perspectives and progress in preoperative portal vein embolization with stem cell augmentation(PVESA)[J].Stem Cell Rev Rep,2024,20:1236-1251.
[61]徐 伟,蔡 飞,黄 剑,等.三维可视化技术在巨块型肝癌PVE治疗中的应用[J].介入放射学杂志,2021,30:1006-1009.
(收稿日期:2024-11-15)
(本文编辑:茹 实)

相似文献/References:

[1]王精兵,安潇,王悍,等.无水乙醇-碘油栓塞治疗肝脏海绵状血管瘤[J].介入放射学杂志,2010,(05):358.
 WANG Jingbing,AN Xiao,WANG Han,et al.Transcatheter arterial embolization with the mixture of ethanol and lipiodol for the treatment of hepatic cavernous hemangiomas[J].J Intervent Med,2010,(05):358.
[2]罗敏,高源统,彭文献,等.磁共振DWI 序列及表观扩散系数值动态评估原发性肝癌介入疗效的应用价值[J].介入放射学杂志,2010,(08):613.
 LUO Min,GAO Yuantong,PENG Wenxian,et al.The application of MR DWI sequences and apparent diffusion coefficient values in dynamic evaluation of the efficacy of transcatheter arterial chemoembolization for primary hepatocellular carcinoma[J].J Intervent Med,2010,(05):613.
[3]王茂强 唐文捷 林汉英 叶慧义 戴光海 王志强.经导管肝动脉化疗栓塞术后胆管损伤的临床意义[J].介入放射学杂志,2005,(05):493.
 WANG Mao-qiang TANG Wen-jie LIN Han-ying YE Hui-yi DAI Guang-hai WANG Zhi-qiang.Clinical implications of bile duct injury after transcatheter arterial chemoembolization[J].J Intervent Med,2005,(05):493.
[4]郭启勇,本田伸行,陈在中,等.经皮经肝沸腾水溶性造影剂注入疗法治疗肝脏肿瘤——基础研究和临床应用[J].介入放射学杂志,1996,(01):47.
[5]李红,徐克,蒋旭远.对兔移植性肝脏肿瘤模型生存素表达调控的实验研究[J].介入放射学杂志,2009,(05):382.
 LI Hong,XU Ke,JIANG Xu-yuan.The regulation of As2O3on the expression of apoptosis inhibitory protein:an experimental study in rabbits with implanted liver tumor[J].J Intervent Med,2009,(05):382.
[6]张琳,牟玮,王健,等.乙酸化学消融联合肝动脉化疗栓塞治疗肝脏恶性肿瘤[J].介入放射学杂志,2007,(12):831.
 ZHANG Lin,MU Wei,WANG Jian,et al.CT fluoroscopic guidance percutaneous acetic acid injection tumor ablation and TACE for the malignant liver tumor[J].J Intervent Med,2007,(05):831.
[7]林志东,文宠佩,符孔,等.胃右动脉起源变异在肝癌介入治疗中的意义[J].介入放射学杂志,2010,(01):32.
 LIN Zhidong,WEN Chongpei,FU Kong,et al.The clinical significance of anomalous origination of right gastric artery in interventional treatment for hepato cellular carcinoma[J].J Intervent Med,2010,(05):32.
[8]郭彦君,李 槐.肝动脉化疗栓塞术所致皮肤损伤并发症分析[J].介入放射学杂志,2011,(06):470.
 GUO Yan-jun,LI Huai..Skin complications caused by transcatheter hepatic arterial chemoembolization for malignant liver tumors[J].J Intervent Med,2011,(05):470.
[9]林志东,文宠佩,符孔,等.肝癌肝外血管多层螺旋CT三维重建的临床应用[J].介入放射学杂志,2010,(08):607.
 LIN Zhidong,WEN Chongpei,FU Kong,et al.Multi-slice spiral CT3D reconstruction of extrahepatic feeding arteries in hepatocellular carcinoma :its clinical applications[J].J Intervent Med,2010,(05):607.
[10]独建库,何伟华,邹 洋,等.经肝动脉化疗栓塞术联合经皮肝穿门静脉大剂量热碘油栓塞治疗肝转移癌[J].介入放射学杂志,2014,(02):115.
 DU Jian? ku,HE Wei? hua,ZOU Yang,et al. Hepatic chemoembolization combined with percutaneous trans?蛳 hepatic puncture of portal vein plus heated Lipiodol infusion for the treatment of metastatic liver carcinoma[J].J Intervent Med,2014,(05):115.

备注/Memo

备注/Memo:
基金项目: 国家重点研发计划(2023YFC2411404)
通信作者: 瞿旭东 E-mail:qu.xudong@zs-hospital.sh.cn
更新日期/Last Update: 2025-05-25