经导管门静脉栓塞术后肝脏再生的实验与临床研究

Experimental and clinical studies on liver regeneration following transcatheter portal embolization.

作者信息

Ishikawa M, Yogita S, Iuchi M, Yagi K, Chikaishi H, Fukuda Y, Miyake H, Harada M, Tashiro S

机构信息

First Department of Surgery, University of Tokushima, School of Medicine, Japan.

出版信息

Hepatogastroenterology. 2000 Jan-Feb;47(31):226-33.

PMID:10690613

Abstract

BACKGROUND/AIMS: We studied compensatory hypertrophy following transcatheter portal embolization experimentally in dogs and clinically under the condition of cholestasis.

METHODOLOGY

Experimental study: Sixteen dogs were used for this study. Transcatheter portal embolization was performed in the left lobes (70% of the total liver) using Gelfoam powder in dogs with 2-week obstructive jaundice. Liver weight, liver blood flow and the intracellular adenosine triphosphate content of isolated hepatocytes were measured after transcatheter portal embolization. Clinical Study: transcatheter portal embolization of the right portal branch was performed in 13 patients with cancer of the biliary tract and 3 patients with hepatocellular carcinoma before (extended) right lobectomy, using Gelfoam powder and thrombin. Six patients who had a total bilirubin level > 5 mg/dLunderwent a percutaneous transhepatic biliary drainage before transcatheter portal embolization. Liver function tests, a volumetric study with computed tomography and immunohistochemical staining for profilerating cell nuclear antigen and apoptosis in the resected livers were performed.

RESULTS

Experimental study: The weight ratio of the non-embolized lobes to the total liver, 2 weeks after transcatheter portal embolization in the dogs with jaundice, was significantly lower than that of the normal dogs with transcatheter portal embolization (40.5 +/- 4.5% vs. 47.6 +/- 3.2%), but significantly larger than that of the dogs without transcatheter portal embolization. The cellular adenosine triphosphate content and tissue blood flow in the embolized lobes were significantly lower than those in the nonembolized lobes in the normal and cholestatic livers. Clinical study: The postoperative course in all patients was uneventful, with no serious complication or liver dysfunction. Extended right lobectomy with caudate lobectomy was equivalent to 65% before transcatheter portal embolization and to 56% after, transcatheter portal embolization owing to compensatory hypertrophy of the left lobe. However, there was no significant difference in liver volume in the patients with or without obstructive jaundice. Apoptosis was observed in the embolized lobe.

CONCLUSIONS

Preoperative transcatheter portal embolization with percutaneous transhepatic biliary drainage for the purpose of liver regeneration would be useful for treating extended hepatectomy with obstructive jaundice.

摘要

背景/目的：我们通过在犬类动物上进行经导管门静脉栓塞术的实验研究，并在临床胆汁淤积的情况下进行观察，来研究代偿性肥大。

方法

实验研究：本研究使用了16只犬。对患有2周阻塞性黄疸的犬，经导管向其左叶（占全肝的70%）注入明胶海绵粉末进行门静脉栓塞。在经导管门静脉栓塞术后，测量肝脏重量、肝血流量以及分离的肝细胞内三磷酸腺苷含量。临床研究：对13例胆管癌患者和3例肝细胞癌患者，在（扩大）右叶切除术前，经导管向其右门静脉分支注入明胶海绵粉末和凝血酶进行栓塞。6例总胆红素水平>5mg/dL的患者在经导管门静脉栓塞术前接受了经皮经肝胆道引流。对切除的肝脏进行肝功能检查、计算机断层扫描容积研究以及增殖细胞核抗原和凋亡的免疫组织化学染色。

结果

实验研究：黄疸犬经导管门静脉栓塞术后2周，未栓塞叶与全肝的重量比显著低于正常犬经导管门静脉栓塞后的比例（40.5±4.5%对47.6±3.2%），但显著高于未进行经导管门静脉栓塞的犬。在正常肝脏和胆汁淤积肝脏中，栓塞叶的细胞三磷酸腺苷含量和组织血流量均显著低于未栓塞叶。临床研究：所有患者术后过程顺利，无严重并发症或肝功能障碍。由于左叶的代偿性肥大，扩大右叶切除加尾状叶切除术前相当于全肝的65%，术后相当于56%。然而，有或无阻塞性黄疸的患者肝脏体积无显著差异。在栓塞叶观察到凋亡。