• 四川大學（成都，610041）1華西醫(yī)院肝臟及血管外科，2華西基礎醫(yī)學院;

將肝動脈內(nèi)的血流引入到門靜脈系統(tǒng)內(nèi)，即門靜脈動脈化技術，已經(jīng)在肝門部膽管癌根治術中得到廣泛應用，但其應用仍存在爭議?，F(xiàn)復習近年來國內(nèi)、外有關門靜脈動脈化在治療肝門部膽管癌的文獻并進行綜述，從而探討門靜脈動脈化在肝門部膽管癌根治術中使用的利弊，以更好地指導臨床工作。

引用本文： 雷建勇,鐘金晶,王文濤,嚴律南. 門靜脈動脈化在肝門膽管癌根治術中的應用研究進展. 華西醫(yī)學, 2012, 27(10): 1561-1565. doi: 復制

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1. 　梁廷波, 湯曉鋒. 肝門部膽管癌的診治現(xiàn)狀[J]. 肝膽外科雜志, 2010, 18(5): 327-331.
2. 　孫誠誼, 汪建新. 肝門部膽管癌的外科治療[J]. 世界華人消化雜志, 2011, 19(8): 771-776.
3. 　湯地, 梁力建, 黃潔夫. 肝門部膽管癌86例的診斷與治療[J]. 中華普通外科雜志, 2001, 16(9): 517-519.
4. 　孫備, 王擁衛(wèi), 姜洪池. 肝門部膽管癌的外科治療進展[J]. 中華消化外科雜志, 2010, 9(3): 237-240.
5. 　Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation[J]. Am J Surg, 1966, 112(3): 337-347.
6. 　Ito F, Cho CS, Rikkers LF, et al. Hilar cholangiocarcinoma: current management[J]. Ann Surg, 2009, 250(2): 210-218.
7. 　Gaudio E, Franchitto A, Pannarale L, et al. Cholangiocytes and blood supply[J]. World J Gastroenterol, 2006, 12(22): 3546-3552.
8. 　Beaussier M, Wendum D, Fouassier L, et al. Adaptative bile duct proliferative response in experimental bile duct ischemia[J]. J Hepatol, 2005, 42(2): 257-265.
9. 　周寧新, 黃志強, 馮玉泉, 等. 肝門部膽管癌根治性切除手術方式的改進[J]. 中華普通外科雜志, 2001, 16(2): 82-84.
10. 　Gerhards MF, van Gulik TM, de Wit LT, et al. Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma: a single center experience[J]. Surgery, 2000, 127(4): 395-404.
11. 　Kondo S, Hirano S, Ambo Y, et al. Arterioportal shunting as an alternative to microvascular reconstruction after hepatic artery resection[J]. Br J Surg, 2004, 91(2): 248-251.
12. 　Zhang JJ, Niu JX, Dong CX, et al. Portal vein arterialization used in partial hepatectomy maintains liver regeneration[J]. Sci Res Essay, 2011, 6(30): 6325-6330.
13. 　陳東, 賴偉明, 梁力建, 等. 肝門部膽管癌切除術中的血管切除重建[J]. 中華外科雜志, 2011, 49(7): 607-610.
14. 　Qiu J, Wu H, Prasoon P, et al. Portal vein arterialization in hilar cholangiocarcinoma: one case report and literature review[J]. Eur J Gastroenterol Hepatol, 2012, 24(3): 229-232.
15. 　Young AL, Prasad KR, Adair R, et al. Portal vein arterialization as a salvage procedure during left hepatic trisectionectomy for hilar cholangiocarcinoma[J]. J Am Coll Surg, 2008, 207(5): e1-e6.
16. 　陳永亮, 黃志強, 周寧新, 等. 門靜脈動脈化在肝門部膽管癌根治性切除術中的應用[J]. 中華普通外科雜志, 2007, 22(6): 404-406.
17. 　Narath A. Über die Entstehung der anämischen Lebernekrose nach Unterbindung der Arteria hepatica undihre Verhütung durch arterio-portale Anastomose[J]. Dtsch Z Chir , 1996, 135(4-5): 305–378.
18. 　李堅, 劉琦, 關曉東, 等. 利用右腎動脈行入肝門靜脈動脈化加門腔分流術的試驗研究[J]. 中華普通外科雜志, 2010, 25(3): 227-230.
19. 　Shimizu Y, Miyazaki M, Shimizu H, et al. Beneficial effects of arterialization of the portal vein on extended hepatectomy[J]. Br J Surg, 2000, 87(6): 784-789.
20. 　Tsivian M, Neri F, Prezzi D, et al. Portal vein arterialization in hepatobiliary surgery and liver transplantation[J]. Transplant Proc, 2007, 39(6): 1877-1878.
21. 　王鵬, 李鵬, 芮理, 等. 門靜脈動脈化對肝硬化犬肝切除后肝再生的作用[J]. 世界華人消化雜志, 2009, 17(24): 2499-2502.
22. 　李堅, 關曉東, 劉琦, 等. 入肝門靜脈動脈化加門腔分流對大鼠肝臟再生的影響[J]. 中山大學學報, 2010, 31(4): 508-512.
23. 　Zhang JJ, Meng XK. Current status and perspectives of application of portal vein arterialization in hepatobiliary surgery[J]. Chin J Hepatob Surg, 17(4): 349-352.
24. 　Guo SH, Li CH, Chen YL, et al. Effects of partial portal vein arterialization on the hilar bile duct in a rat model[J]. Hepatobiliary Pancreat Dis Int, 2011, 10(5): 533-538.
25. 　吳葆瑩, 吳崇旭, 薛承銳, 等. 門靜脈動脈化對梗阻性黃疸的臨床應用[J]. 江蘇醫(yī)藥, 2010, 36(12): 1465-1466.
26. 　Jang JS, Park DJ. Actual long-term outcome of extrahepatic bile duct Cancer after surgical resection[J]. Ann Surg, 2005, 241(1):77-84.
27. 　Parikh AA. Abdalla EK, Vauthey JN. Operative considerations in resection of hilar cholangiocarcinoma[J]. HPB, 2005, 7(4): 254-258.
28. 　沈世強, 張訓臣. 肝切除時門靜脈血部分動脈化的研究[J]. 中華實驗外科雜志, 2000, 17(3): 235-236.
29. 　郭少華, 陳永亮, 李崇輝, 等. 部分門靜脈動脈化后肝門部膽管細胞增生的試驗研究[J]. 解放軍醫(yī)學雜志, 2010, 35(10): 1212-1214.
30. 　陳嘉偉, 唐啟彬, 王捷. 門靜脈動脈化對肝臟及膽管周圍血管叢的影響[J]. 嶺南現(xiàn)代臨床外科, 2009, 9(5): 351-352,356.
31. 　陳永亮, 黃志強, 趙建更, 等. 部分門靜脈動脈化重建肝血流的實驗研究[J]. 中華普通外科雜志, 2002, 17(5): 289-290.
32. 　Schleimer K, Stippel DL, Kasper HU, et al. Portal vein arterialization increases hepatocellular apoptosis and inhibits liver regeneration[J]. J Surg Res, 2008, 149(2): 250-258.
33. 　李文崗, 黃志強, 高麗杰, 等. 門靜脈動脈化后大鼠門靜脈血液動力學改變對肝臟功能的遠期影響[J]. 吉林大學學報·醫(yī)學版, 2005, 31(2): 213-216.
34. 　Lnoue T, Sawa T, Okada S, et al. Partial portal arterialization in complete en bloc resection of the hepatoduodenal ligament and left lobe of the liver for hepatic hilar Cancer[J]. Hepatogastroenterology, 2000, 47(32): 533-536.
35. 　陳永亮, 黃志強, 王迎賓. 門靜脈動脈化對實驗性梗阻性黃疸大鼠肝細胞凋亡的影響[J]. 中華普通外科雜志, 2000, 15(6): 348-351.
36. 　陳永亮, 黃曉強, 黃志強, 等. 限制流量的部分門靜脈動脈化重建肝血流的實驗研究[J]. 解放軍醫(yī)學雜志, 2007, 32(3): 218-220.
37. 　陳永亮, 黃曉強, 黃志強, 等. 限制流量部分門靜脈動脈化的臨床應用研究[J]. 醫(yī)學研究雜志, 2011, 40(9): 35-37.
38. 　陳永亮, 黃曉強, 黃志強, 等. 限制流量部分門靜脈動脈化重建肝血流的臨床觀察[J]. 中華普通外科雜志, 2011, 26(3): 259.
39. 　李文崗, 李濱, 高麗杰, 等. 限制流量門靜脈動脈化對大鼠肝臟功能和結構的遠期影響[J]. 中華普通外科雜志, 2006, 21(1): 55-58.
40. 　Li WG, Chen YL, Chen JX, et al. Portal venous arterialization resulting in increased portal inflow and portal vein wall thickness in rats[J]. World J Gastroenterol, 2008, 14(43): 6681-6688.
41. 　Pastor CM. Hepatic and splanchnic oxygen consumption during acute hypoxemic hypoxia in anesthetized pigs[J]. Crit Care Med, 2000, 28(3): 765-773.
42. 　Maggi U, Camagni S, Reggiani P, et al. Portal vein arterialization for hepatic artery thrombosis in liver transplantation: a case report, Doppler-ultrasound aspects, and review of the literature[J]. Transplant Proc, 2010, 42(4): 1369-1374.
43. 　Housari G, Nuño J, Calero P, et al. Portal vein arterialization in liver transplantation: an option to restore arterial flow: a case report[J]. Transplant Proc, 2011, 43(3): 755-757.
44. 　Bonnet S, Sauvanet A, Bruno O, et al. Long-term survival after portal vein arterialization for portal vein thrombosis in orthotopic liver transplantation[J]. Gastroentérologie clinique et biologique, 2010, 34(1): 23-28.
45. 　Li Destri G, La Greca G, Greco L, et al. Arterialization of the portal stump by right renal artery after portocaval shunt in the rat[J]. Microsurgery, 2004, 24(1): 77-80.
46. 　Chen YL, Li WG, Huang ZQ, et al. Effects of portal venous arterialization on acute occlusion of hepatic artery in rats[J]. Chin Med J (Engl), 2008, 121(14): 1302-1306.
  1. 1. 　梁廷波, 湯曉鋒. 肝門部膽管癌的診治現(xiàn)狀[J]. 肝膽外科雜志, 2010, 18(5): 327-331.
  2. 2. 　孫誠誼, 汪建新. 肝門部膽管癌的外科治療[J]. 世界華人消化雜志, 2011, 19(8): 771-776.
  3. 3. 　湯地, 梁力建, 黃潔夫. 肝門部膽管癌86例的診斷與治療[J]. 中華普通外科雜志, 2001, 16(9): 517-519.
  4. 4. 　孫備, 王擁衛(wèi), 姜洪池. 肝門部膽管癌的外科治療進展[J]. 中華消化外科雜志, 2010, 9(3): 237-240.
  5. 5. 　Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation[J]. Am J Surg, 1966, 112(3): 337-347.
  6. 6. 　Ito F, Cho CS, Rikkers LF, et al. Hilar cholangiocarcinoma: current management[J]. Ann Surg, 2009, 250(2): 210-218.
  7. 7. 　Gaudio E, Franchitto A, Pannarale L, et al. Cholangiocytes and blood supply[J]. World J Gastroenterol, 2006, 12(22): 3546-3552.
  8. 8. 　Beaussier M, Wendum D, Fouassier L, et al. Adaptative bile duct proliferative response in experimental bile duct ischemia[J]. J Hepatol, 2005, 42(2): 257-265.
  9. 9. 　周寧新, 黃志強, 馮玉泉, 等. 肝門部膽管癌根治性切除手術方式的改進[J]. 中華普通外科雜志, 2001, 16(2): 82-84.
  10. 10. 　Gerhards MF, van Gulik TM, de Wit LT, et al. Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma: a single center experience[J]. Surgery, 2000, 127(4): 395-404.
  11. 11. 　Kondo S, Hirano S, Ambo Y, et al. Arterioportal shunting as an alternative to microvascular reconstruction after hepatic artery resection[J]. Br J Surg, 2004, 91(2): 248-251.
  12. 12. 　Zhang JJ, Niu JX, Dong CX, et al. Portal vein arterialization used in partial hepatectomy maintains liver regeneration[J]. Sci Res Essay, 2011, 6(30): 6325-6330.
  13. 13. 　陳東, 賴偉明, 梁力建, 等. 肝門部膽管癌切除術中的血管切除重建[J]. 中華外科雜志, 2011, 49(7): 607-610.
  14. 14. 　Qiu J, Wu H, Prasoon P, et al. Portal vein arterialization in hilar cholangiocarcinoma: one case report and literature review[J]. Eur J Gastroenterol Hepatol, 2012, 24(3): 229-232.
  15. 15. 　Young AL, Prasad KR, Adair R, et al. Portal vein arterialization as a salvage procedure during left hepatic trisectionectomy for hilar cholangiocarcinoma[J]. J Am Coll Surg, 2008, 207(5): e1-e6.
  16. 16. 　陳永亮, 黃志強, 周寧新, 等. 門靜脈動脈化在肝門部膽管癌根治性切除術中的應用[J]. 中華普通外科雜志, 2007, 22(6): 404-406.
  17. 17. 　Narath A. Über die Entstehung der anämischen Lebernekrose nach Unterbindung der Arteria hepatica undihre Verhütung durch arterio-portale Anastomose[J]. Dtsch Z Chir , 1996, 135(4-5): 305–378.
  18. 18. 　李堅, 劉琦, 關曉東, 等. 利用右腎動脈行入肝門靜脈動脈化加門腔分流術的試驗研究[J]. 中華普通外科雜志, 2010, 25(3): 227-230.
  19. 19. 　Shimizu Y, Miyazaki M, Shimizu H, et al. Beneficial effects of arterialization of the portal vein on extended hepatectomy[J]. Br J Surg, 2000, 87(6): 784-789.
  20. 20. 　Tsivian M, Neri F, Prezzi D, et al. Portal vein arterialization in hepatobiliary surgery and liver transplantation[J]. Transplant Proc, 2007, 39(6): 1877-1878.
  21. 21. 　王鵬, 李鵬, 芮理, 等. 門靜脈動脈化對肝硬化犬肝切除后肝再生的作用[J]. 世界華人消化雜志, 2009, 17(24): 2499-2502.
  22. 22. 　李堅, 關曉東, 劉琦, 等. 入肝門靜脈動脈化加門腔分流對大鼠肝臟再生的影響[J]. 中山大學學報, 2010, 31(4): 508-512.
  23. 23. 　Zhang JJ, Meng XK. Current status and perspectives of application of portal vein arterialization in hepatobiliary surgery[J]. Chin J Hepatob Surg, 17(4): 349-352.
  24. 24. 　Guo SH, Li CH, Chen YL, et al. Effects of partial portal vein arterialization on the hilar bile duct in a rat model[J]. Hepatobiliary Pancreat Dis Int, 2011, 10(5): 533-538.
  25. 25. 　吳葆瑩, 吳崇旭, 薛承銳, 等. 門靜脈動脈化對梗阻性黃疸的臨床應用[J]. 江蘇醫(yī)藥, 2010, 36(12): 1465-1466.
  26. 26. 　Jang JS, Park DJ. Actual long-term outcome of extrahepatic bile duct Cancer after surgical resection[J]. Ann Surg, 2005, 241(1):77-84.
  27. 27. 　Parikh AA. Abdalla EK, Vauthey JN. Operative considerations in resection of hilar cholangiocarcinoma[J]. HPB, 2005, 7(4): 254-258.
  28. 28. 　沈世強, 張訓臣. 肝切除時門靜脈血部分動脈化的研究[J]. 中華實驗外科雜志, 2000, 17(3): 235-236.
  29. 29. 　郭少華, 陳永亮, 李崇輝, 等. 部分門靜脈動脈化后肝門部膽管細胞增生的試驗研究[J]. 解放軍醫(yī)學雜志, 2010, 35(10): 1212-1214.
  30. 30. 　陳嘉偉, 唐啟彬, 王捷. 門靜脈動脈化對肝臟及膽管周圍血管叢的影響[J]. 嶺南現(xiàn)代臨床外科, 2009, 9(5): 351-352,356.
  31. 31. 　陳永亮, 黃志強, 趙建更, 等. 部分門靜脈動脈化重建肝血流的實驗研究[J]. 中華普通外科雜志, 2002, 17(5): 289-290.
  32. 32. 　Schleimer K, Stippel DL, Kasper HU, et al. Portal vein arterialization increases hepatocellular apoptosis and inhibits liver regeneration[J]. J Surg Res, 2008, 149(2): 250-258.
  33. 33. 　李文崗, 黃志強, 高麗杰, 等. 門靜脈動脈化后大鼠門靜脈血液動力學改變對肝臟功能的遠期影響[J]. 吉林大學學報·醫(yī)學版, 2005, 31(2): 213-216.
  34. 34. 　Lnoue T, Sawa T, Okada S, et al. Partial portal arterialization in complete en bloc resection of the hepatoduodenal ligament and left lobe of the liver for hepatic hilar Cancer[J]. Hepatogastroenterology, 2000, 47(32): 533-536.
  35. 35. 　陳永亮, 黃志強, 王迎賓. 門靜脈動脈化對實驗性梗阻性黃疸大鼠肝細胞凋亡的影響[J]. 中華普通外科雜志, 2000, 15(6): 348-351.
  36. 36. 　陳永亮, 黃曉強, 黃志強, 等. 限制流量的部分門靜脈動脈化重建肝血流的實驗研究[J]. 解放軍醫(yī)學雜志, 2007, 32(3): 218-220.
  37. 37. 　陳永亮, 黃曉強, 黃志強, 等. 限制流量部分門靜脈動脈化的臨床應用研究[J]. 醫(yī)學研究雜志, 2011, 40(9): 35-37.
  38. 38. 　陳永亮, 黃曉強, 黃志強, 等. 限制流量部分門靜脈動脈化重建肝血流的臨床觀察[J]. 中華普通外科雜志, 2011, 26(3): 259.
  39. 39. 　李文崗, 李濱, 高麗杰, 等. 限制流量門靜脈動脈化對大鼠肝臟功能和結構的遠期影響[J]. 中華普通外科雜志, 2006, 21(1): 55-58.
  40. 40. 　Li WG, Chen YL, Chen JX, et al. Portal venous arterialization resulting in increased portal inflow and portal vein wall thickness in rats[J]. World J Gastroenterol, 2008, 14(43): 6681-6688.
  41. 41. 　Pastor CM. Hepatic and splanchnic oxygen consumption during acute hypoxemic hypoxia in anesthetized pigs[J]. Crit Care Med, 2000, 28(3): 765-773.
  42. 42. 　Maggi U, Camagni S, Reggiani P, et al. Portal vein arterialization for hepatic artery thrombosis in liver transplantation: a case report, Doppler-ultrasound aspects, and review of the literature[J]. Transplant Proc, 2010, 42(4): 1369-1374.
  43. 43. 　Housari G, Nuño J, Calero P, et al. Portal vein arterialization in liver transplantation: an option to restore arterial flow: a case report[J]. Transplant Proc, 2011, 43(3): 755-757.
  44. 44. 　Bonnet S, Sauvanet A, Bruno O, et al. Long-term survival after portal vein arterialization for portal vein thrombosis in orthotopic liver transplantation[J]. Gastroentérologie clinique et biologique, 2010, 34(1): 23-28.
  45. 45. 　Li Destri G, La Greca G, Greco L, et al. Arterialization of the portal stump by right renal artery after portocaval shunt in the rat[J]. Microsurgery, 2004, 24(1): 77-80.
  46. 46. 　Chen YL, Li WG, Huang ZQ, et al. Effects of portal venous arterialization on acute occlusion of hepatic artery in rats[J]. Chin Med J (Engl), 2008, 121(14): 1302-1306.