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[Rehabilitation of the portal vein. Anatomical, experimental and clinical observations of liver metastases].

We have studied the macroscopic anatomy of the portal vein to explain the distribution of metastatic emboli, by the orientation of its branches and its internal flows. Its termination seen under the microscope permits, by knowledge of the portal microcirculation of the lobule, one to localise nidation of these emboli in the hepatic sinus and, to explain their proliferation, without neglecting the dynamic role of the hepatic artery through the numerous arterio-portal anastomoses. The portal blood flow is essential to liver regeration even if arterio-biliary proliferation provides the initial impulsion. Interruption of a portal branch produces hepatic atrophy with resultant metabolic disorders. In this context, a precise physiopathological approach permits one to consider the consequences of metastases and, particularly, porto-lymphatic reflux which explains the topography and onset of new emboli. The study of the portal system is an important factor in the decision to operate widely. A nutrient route, the portal vein is followed by the metastasis, it may be interrupted by ligature to prevent the latter. Finally it is an efficacious route for destruction of macroscopic foci (chemotherapy) or prevention and destruction of infraclinical foci (active non-specific loco-regional immunotherapy).