Preoperative portal vein embolization for extension of hepatectomy indications
Preoperative portal vein embolization for extension of hepatectomy indications
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DOI：
10.1002/hep.510240612
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发表时间：
1996-12-01
期刊：
影响因子：
13.5
通讯作者：
Bousson, V
中科院分区：
文献类型：
--
作者：
deBaere, T;Roche, A;Bousson, V
为了使肝切除术在未来残肝（FRL）初始体积不足的患者中可行，我们将富含肝营养物质的门静脉血流重新分配到FRL，通过术前门静脉栓塞（POPE）实现重新分配，为未来切除的肝脏供血，31例患者在荧光镜引导下经皮穿刺进行POPE，POPE耐受性良好，24例患者手术可行，术后无严重肝功能衰竭。7例手术取消，但只有1例因FRL肥大不足，FRL体积值为90 - 560 mL（平均260公吨）和160-783公吨（平均443 mt），代表中位增加79% +/-50%，使用氰基丙烯酸酯30天后FRL肥大为90% +/- 52%，明胶海绵43天后为53% +/- 6%，弹簧圈35天后为44% +/- 30%。栓塞的肝脏体积略有缩小，计划切除，总生存期为2-62个月平均26个月，无病生存期0-60个月平均19个月，7例无瘤生存14 ~ 60个月尽管仅适用于有限的患者子集，但POPE扩大了治愈性肝切除术的可能性，因为它诱导未栓塞肝段的良好肥大。氰基丙烯酸酯似乎可以确保更好更快的肥大。
To render hepatectomy feasible in patients with an initially deficient volume of the future remnant liver (FRL), we redistributed portal blood flow rich in hepato trophic substances toward the FRL, Redistribution was achieved with preoperative portal vein embolization (POPE) feeding the future resected liver, POPE was performed in 31 patients, under fluoroscopic guidance, via a percutaneous access, POPE was well tolerated and surgery was practicable in 24 patients without severe postoperative liver failure, Seven operations were cancelled, but only one due to insufficient hypertrophy of the FRL, FRL volume values were 90 to 560 mL (mean 260 mt) before POPE and 160-783 mt (mean 443 mt) after POPE, which represents a median increase of 79% +/- 50%, Hypertrophy of the FRL was 90% +/- 52% after 30 days with cyanoacrylate, 53% +/- 6% after 43 days with Gelfoam, and 44% +/- 30% after 35 days with coils. Slight shrinkage was obtained in the volume of the embolized liver, for which resection was planned, Overall survival was 2-62 months (mean 26 months), disease-free survival was 0-60 months (mean 19 months), and 7 patients are disease-free and alive 14 to 60 months (mean 43 months) after surgery, Although exclusively applicable in a Limited subset of patients, POPE widens the possibilities of curative hepatectomies, because it induces sound hypertrophy of unembolized liver segments. Cyanoacrylate seems to ensure better and faster hypertrophy.