oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2025-24-2-144-149oncotomsk-3546Research ArticleОБЗОРЫREVIEWSСравнительная характеристика эмболизации и лигирования правой ветви портальной вены (обзор литературы)Comparative characteristics of embolization and ligation of the right branch of the portal vein (literature review)https://orcid.org/0009-0007-6690-6816ЛадыкК. К.LadykK. K.

Ладык Константин Константинович, хирург отделения хирургии № 1 

Донецкая Народная Республика, г. Донецк, 283045, пр. Ленинский, 47

Konstantyn K. Ladyk, MD, Surgeon, Department of Surgery No. 1 

47, Leninsky Ave., Donetsk, 283045, Donetsk People's Republic 

dfh346@rambler.ruhttps://orcid.org/0000-0003-0260-6922ИщенкоР. В.IshchenkoR. V.

Ищенко Роман Викторович, доктор медицинских наук, директор 

Донецкая Народная Республика, г. Донецк, 283045, пр. Ленинский, 47

Roman V. Ishchenko, MD, DSc, Director 

47, Leninsky Ave., Donetsk, 283045, Donetsk People's Republic 

https://orcid.org/0000-0003-0141-8719КостяминЮ. Д.KostyaminY. D.

Костямин Юрий Дмитриевич, кандидат медицинских наук, хирург, заведующий отделением рентгенохирургических методов диагностики и лечения № 2

Донецкая Народная Республика, г. Донецк, 283045, пр. Ленинский, 47

Yurii D. Kostyamin, MD, PhD, Surgeon, Head of the Department of X-ray Surgical Diagnostic and Treatment Methods No. 2 

47, Leninsky Ave., Donetsk, 283045, Donetsk People's Republic 

ФГБУ «ИНВХ им. В.К. Гусака» Минздрава РоссииРоссияV.K. Gusak Institute of Emergency and Reconstructive Surgery of the Ministry of Health of RussiaRussian Federation202517052025242144149Copyright © Ладык К.К., Ищенко Р.В., Костямин Ю.Д., 20252025Ладык К.К., Ищенко Р.В., Костямин Ю.Д.Ladyk K.K., Ishchenko R.V., Kostyamin Y.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/3546

Цель исследования - сравнение методов механической редукции кровотока в правой ветви портальной вены (эмболизация, portal vein embolization - PVE и лигирование, portal vein ligation - PVL) как неоадъювантного этапа лечения перед обширными резекциями печени с целью индукции викарной гипертрофии ремнанта (future liver remnant - FLR) для профилактики пострезекционной печеночной недостаточности (ПРПН) на основе анализа литературных данных. Материал и методы. Проведен анализ 28 литературных источников, опубликованных с 2001 по 2024 г. в таких базах данных, как PubMed, ScienceDirect, International Hepato-Pancreato-Biliary Association. Поиск статей в базе данных PubMed выполнялся с тегами «portal vein embolization» и «portal vein ligation» с параметрами «Free full text», «Review», «5 years», как релевантные отобрано 22 статьи. Заключение. В результате анализа литературных данных выяснилось, что в ходе сравнительной характеристики PVE и PVL однозначного мнения авторов по поводу степени гипертрофии FLR при первом или втором методе, в целом, не прослеживается. Однако большинство авторов рекомендуют применять PVL. В отношении временного интервала между PVE/PVL и вторым этапом операции также нет единой точки зрения. Значимая часть авторов для усиления регенераторного потенциала рекомендуют дополнительную эмболизацию IV сегмента, что сопряжено с техническими сложностями и требует наработанных навыков. Широко освещена проблема постокклюзионного прогрессирования опухолевого процесса, чаще всего после PVE. Данный факт объясняется гемодинамической перестройкой, стимуляцией выработки цитокинов и факторов роста. Представлены случаи недостаточной гипертрофии FLR как результат развития внутрипеченочных коллатералей, особенно после PVL. В качестве альтернативного метода, способтвующего профилактике данного явления, предложена ALPPS (Associated Liver Partition and Portal vein ligation for Staged hepatectomy). Осложнения после PVE/PVL освещены скудно, с единичными описаниями контрлатеральной эмболизации, внутрибрюшной холереи либо геморрагии, отдаленного перипортального фиброза. На данный момент PVE остается золотым стандартом в качестве первого этапа при двухэтапных обширных резекциях печени, предупреждающим развитие пострезекционной печеночной недостаточности.

The purpose of the study was to compare the methods of mechanical reduction of blood flow in the right branch of the portal vein: portal vein embolization (PVE) and portal vein ligation (PVL) as a neoadjuvant treatment before extended hepatectomy to induce hypertrophy of the future liver remnant (FLR) for the prevention of post-resection hepatic failure (PRHF). Material and Methods. A total of 28 publications from PubMed and ScienceDirect databases, the International Hepato-Pancreato-Biliary Association, monographs and guidelines for physicians, covering the period from 2001 to 2004, were analyzed. The search for articles in the PubMed database was conducted using the key words: “portal vein embolization” and “portal vein ligation” with the parameters “Free full text”, “Review”, “5 years”. 22 articles were selected as relevant. Conclusion. In general, no clear and unanimous opinion was found among the authors regarding the rate of FLR hypertrophy between the PVE and PVL methods. However, most authors recommended PVL. As for the time interval from PVE/PVL to the second stage of surgery, the opinions were equally bipolar. Many authors recommended additional segment IV embolization to enhance the regenerative potential, which is associated with technical difficulties and requires advanced skills. The problem of post-occlusion tumor progression was widely reported, the highest percentage of cases was described after PVE. This fact is explained by hemodynamic restructuring, stimulation of cytokine and growth factor production. The cases of insufficient FLR hypertrophy due to the development of intrahepatic collaterals, especially after PVL, were described. Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) was proposed as an alternative to prevent this complication. Complications after PVE/PVL were poorly described, with isolated reports of contralateral embolization, intra-abdominal choleraemia or hemorrhage, and distant periportal fibrosis. To date, PVE remains the gold standard as the first stage of two-stage extensive liver resections, as a prevention of post-resection liver failure.

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The authors declare that there are no conflicts of interest present.