Preoperative Percutaneous Transhepatic Portal Vein Embolization With Ethanol Injection
Preoperative Percutaneous Transhepatic Portal Vein Embolization With Ethanol Injection
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DOI：
10.2214/ajr.11.6515
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发表时间：
2012-04-01
影响因子：
5
通讯作者：
Terae, Satoshi
中科院分区：
文献类型：
--
作者：
Sakuhara, Yusuke;Abo, Daisuke;Terae, Satoshi
OBJECTIVE.本文的目的是评价术前经皮肝穿刺门静脉无水乙醇栓塞的可行性和有效性。我们回顾性评价了143例接受经皮经肝门静脉栓塞术的患者。通过比较经皮肝穿刺门静脉栓塞前后CT图像数据获得的体积数据，评估未来肝残体的肥大。有效性评价基于未来肝脏残留的绝对体积变化以及未来肝脏残留与总估计肝脏体积的比值。143例患者中有10例（7.0%）因再通和未来肝脏残留物肥大不足而接受额外栓塞。未来肝脏残留比例的平均增加为33.6%（p < 0.0001），未来肝脏残留与总估计肝脏体积的平均比例从34.9%增加到45.7%（p < 0.0001）。虽然大多数患者在注射乙醇后抱怨疼痛，但通过保守治疗，他们在几分钟内逐渐缓解疼痛。47/151例（31.1%）经皮经肝门静脉栓塞治疗后报告发热（38-39 ℃），并在几天内消退。术后观察到肝脏转氨酶一过性升高，并在约一周内消退。151例经皮经肝穿刺门静脉栓塞治疗中有9例（6%）发生了严重并发症，但没有患者发生肝功能不全或严重并发症而无法成功切除。120例患者行肝切除术，2例患者术后发生肝功能衰竭。术前经皮肝穿刺门静脉无水乙醇栓塞是一种可行而有效的方法，以获得未来的残肝肥大，以防止肝切除术后肝功能衰竭。
OBJECTIVE. The purpose of this article is to evaluate the feasibility and efficacy of preoperative percutaneous transhepatic portal vein embolization with ethanol injection.MATERIALS AND METHODS. We retrospectively evaluated 143 patients who underwent percutaneous transhepatic portal vein embolization. Hypertrophy of the future liver remnant was assessed by comparing the volumetric data obtained from CT image data before and after percutaneous transhepatic portal vein embolization. The evaluation of effectiveness was based on changes in the absolute volume of the future liver remnant and the ratio of the future liver remnant to the total estimated liver volume.RESULTS. Ten of 143 patients (7.0%) underwent additional embolization because of recanalization and insufficient hypertrophy of the future liver remnant. The mean increase in the ratio of the future liver remnant was 33.6% (p < 0.0001), and the mean ratio of future liver remnant to total estimated liver volume increased from 34.9% to 45.7% (p < 0.0001). Although most of the patients complained of pain after ethanol injection, they were gradually relieved of pain in a few minutes by conservative treatment. Fever (38-39 C) was reported after 47 of 151 (31.1%) percutaneous transhepatic portal vein embolization sessions and was resolved within a few days. Transient elevation of the liver transaminases was observed after the procedures and resolved within about a week. Major complications occurred in nine of 151 (6%) percutaneous transhepatic portal vein embolization sessions, but no patients developed hepatic insufficiency or severe complications precluding successful resection. One hundred twenty patients underwent hepatic resection, and two patients developed hepatic failure after surgery.CONCLUSION. Preoperative percutaneous transhepatic portal vein embolization with ethanol is a feasible and effective procedure to obtain hypertrophy of the future liver remnant for preventing hepatic failure after hepatectomy.