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How to predict the success of liver surgery? Explore the key indicators of portal embolization of hepatic portal embolization!
In liver surgery, how to accurately predict the success of the surgery is an important topic.Hepatic portal venous embolization (PVE), as a preoperative procedure, has been shown to significantly increase the expected residual liver volume, thereby increasing the success rate of the surgery.Behind this technology, there are a series of key indicators and considerations, which will explore in-depth how these indicators affect the outcome of liver surgery.
Hepatoportal embolization is an interventional radiological procedure that stimulates the hyperplasia of healthy liver tissue by intervening in the liver blood flow.
Medical uses and indications
The indications for portal embolization are mainly related to the proportion of future liver residual volume (FLR) and total estimated liver volume (TELV).Depending on the health of the liver, it is recommended that the FLR/TELV ratio should reach at least 25% for normal liver patients.For patients with chronic liver disease, such as cirrhosis, the proportion should reach at least 40%.In some patients who have received extensive chemotherapy, hepatic portal embolization is also recommended to improve FLR when the FLR/TELV ratio is less than 30%.
Results and success rate
PVE, as a well-tolerated program, has extremely low mortality and technical failure rates.According to statistics, the mortality rate is only 0.1%, and the technical failure rate is 0.4%.Although complications of PVE include hepatic venous thrombosis, liver infarction and infection, the overall complication rate is about 2–3%.The success of this technology depends on some key indicators, including the patient's underlying liver condition and previous comorbidities.
Study shows that the five-year survival rate of patients undergoing large-scale hepatic resection after PVE can reach 29%.
Contraindications and risks
While PVE can significantly improve the outcome of liver surgery, this technique needs to be avoided in some cases.Hiral hypertension is an absolute contraindication because such patients are not suitable for surgery and face higher risk of complications.In addition, existing complete hepatic lobe portal vein occlusion will also hinder the expected growth of FLR.Other contraindications include poor systemic health of the patient, such as poor cardiopulmonary function, sepsis, etc.
The potential risks of PVE include hepatic venous thrombosis, liver infarction and related surgical complications.
PVE mechanism
PVE promotes the proliferation of healthy tissues by blocking blood flow from a portion of the liver.This change stimulates rapid proliferation of liver cells when blood flow is directed to other areas, and FLR growth is usually expected to be around 10%.In addition, this growth is driven by cell hyperplasia, rather than the cellular hypertropy of existing cells.
The direction of the future
With the advancement of medical technology, PVE technology is also continuing to evolve.For example, transarterial PVE technology has shown significant FLR growth in pig experiments.The reversible PVE method may also be used in the future to treat patients with chronic liver insufficiency, and these advances are expected to promote the success rate of liver surgery.
Hepatic portal embolization is not only a technical means, but also an important tool to explore and improve the success rate of liver surgery.For future liver surgery patients, what kind of technological innovation can further enhance their survival hope?
