A Preliminary Study On Hepatic Hemodynamic Changes In Primary Liver Cancer During ALPPS-Ⅰ Perioperative Period And Their Relationships With The Residual Liver Volume Regeneration

Objiective: To explore the hemodynamic changes of the portal vein and hepatic artery during the perioperative period of ALPPS-Ⅰ by ultrasound and their relationships with the regeneration of future liver remnant.Methods: The clinical data of 23 patients with primary hepatic carcinoma who successfully underwent ALPPS-Ⅰ surgery in the Hepatobiliary Surgery Department of the First Affiliated Hospital of Guangxi Medical University from July 2018 to November 2019 were retrospectively analyzed.The diameters and blood flow of portal vein were monitored by ultrasound before and after LPPVL in ALPPS-Ⅰ and on 1 day before operation and 1st,3rd,5th,7th and 10 th day after operation.The diameters,blood flow,blood flow resistance index(RI),blood flow pulsation index(PI)of hepatic artery were also monitored by ultrasound before and after LPPVL in ALPPS-Ⅰ and on 1 day before operation and 1st,3rd,5th,7th and 10 th day after operation.Then analyzed the hemodynamic changes of portal vein and hepatic artery and their relationships with the residual liver volume regeneration during ALPPS-Ⅰ perioperative periodResults:(1)Hemodynamics post-LPPVL during ALPPS-Ⅰ compared with pre-LPPVL:The blood flow of the left portal vein and the perfusion volume of the portal vein per unit of liver volume(i PVF)of FLR were increased.The blood flow of the main portal vein and the left branch of the hepatic artery were decreased.The RI and PI of right hepatic artery and hepatic artery were also reduced.All differences were statistically significant(P <0.05).RI and PI of left hepatic artery were higher.Blood flow of right hepatic artery and hepatic artery were decreased.The differences were not statistically significant.(2)The hemodynamics after ALPPS-Ⅰ compared with 1 day before ALPPS-Ⅰ :The RI and PI of the left hepatic artery,right hepatic artery,and hepatic artery were decreased,and the differences were statistically significant excpet the PI on the 1st day postoperative of left hepatic artery.The blood flow of left hepatic artery,right hepatic artery,hepatic artery and left branch portal vein were increased.When compared with the day 1before surgery,the differences in blood flow of the right hepatic artery on 10 th day and the hepatic artery on 3rd and 5th day were statistically significant(P<0.05).There were also statistically significant differences in the blood flow of the left portal vein on 3rd,5th,and 10 th day compared with 1 day before surgery(P <0.05).The inner diameters of the hepatic artery and the left branch of the portal vein showed a widening trend,and the blood flow of the main portal vein decreasd.The differences were not statistically significant.(3)RI of left hepatic artery(r = 0.522,P = 0.011)and i PVF(r = 0.429,P = 0.041)after LPPVL in ALPPS-Ⅰ,blood flow of hepatic arterial on the 7th day after the ALPPS-Ⅰ(r=0.480,P = 0.019)were moderately positively correlated with the FLR hyperplasia rate.RI of hepatic artery on 3rd day(r =-0.524,P = 0.010),RI of hepatic artery on 5th day(r =-0.418,P = 0.047)after ALPPS-Ⅰ and FLR before ALPPS-Ⅰ(r =-0.505,P = 0.014)showed a moderate negative correlation with the FLR hyperplasia rate.Conclusion: Dynamic monitoring of ALPPS-Ⅰ perioperative hemodynamic changes using ultrasound are effective and feasible.The correlation between portal vein blood flow,hepatic artery blood flow,RI and FLR hyperplasia rate are statistically significant during ALPPS-Ⅰ perioperative.Dynamic monitoring of ALPPS-Ⅰ perioperative hemodynamic changes can provide timely hepatic hemodynamic changes for clinical diagnosis and treatment,and provide a basis for predicting the regeneration of FLR after surgery.And it has certain clinical application value.