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The Miracle of Liver Regeneration: How Can Hepatic Portal Vein Embolization Make Impossible Liver Resection a Reality?
In the field of liver surgery, hepatic portal vein embolization (PVE) is a crucial technology, which can bring hope to cases that were originally unable to be safely resected due to insufficient liver volume. The implementation of this procedure not only enhances the regenerative potential of the liver, but also provides patients with better treatment options. With the advancement of medical technology, the application of PVE continues to expand and is positioned as an important pretreatment before liver resection.
Medical uses of hepatic portal vein embolization
The indication for hepatic portal vein embolization relies on the ratio of predicted future liver residual volume (FLR) to total estimated liver volume (TELV). For patients with normal livers, the FLR/TELV ratio should be at least 25%, while for patients with chronic liver disease, such as cirrhosis, the recommended ratio should be 40%. The goal of PVE is to stimulate the growth of healthy areas of the liver by blocking blood flow.
Hepatic portal vein embolization is considered to be very tolerated, with a very low mortality rate (0.1%) and a technical failure rate of only 0.4%. The complication rate after surgery is also less than 3%.
Results and effectiveness
The success of PVE mainly depends on the patient's basic liver condition and the use of technology. Studies have shown that patients with initially unresectable tumors have a five-year survival rate of 29% after resection via PVE. Although there were concerns that PVE might promote tumor growth, a systematic review showed that there was no significant difference in postoperative liver recurrence and three- and five-year overall survival rates, indicating that the impact of PVE on tumor metastasis is weak.
Risks, pros and cons of surgery
The risks of PVE after surgery include liver infarction, necrosis, and portal hypertension, but its advantage is that it can reduce postoperative complications and hospitalization time. For patients with tumors that were initially unresectable due to insufficient FLR, PVE provides them with the opportunity to re-evaluate surgery, thereby improving survival probability.
Mechanism analysis
During the PVE process, blood flow in a certain part of the liver is blocked and blood flow in other areas is stimulated, thereby promoting liver regeneration. Hyperplasia is caused by an increase in the number of functioning liver cells rather than an increase in the size of the original liver cells. This regeneration process typically begins within a few hours, and the final FLR growth is expected to be over 10%.
Future development direction
Currently, scientists are exploring a variety of new technologies to enhance the effect of PVE. These include reversible PVE and therapies combined with stem cell transplantation. For example, transarterial PVE has shown more significant FLR proliferation in animal experiments, and may become a new treatment option once successful in human trials.
However, these new methods still require further research and clinical trials to confirm their effectiveness and safety.
With further research into the mechanisms of liver regeneration, we may be able to better understand how to use these innovative technologies to improve patients' quality of life and overcome challenging liver diseases. Have you ever thought about how these technological advances will change the future treatment of liver diseases?
