Inaba S, Takada T, Amano H, Yoshida M, Yamakawa Y, Yasuda H, Takada Y, Takeshita K, Koutake H, Takada K, Furui S, Hijikata H, Takada K
First Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 2000 Jul-Aug;47(34):1077-81.
BACKGROUND/AIMS: Preoperative transhepatic portal vein embolization may not always be sufficient to achieve the desired changes in contralateral hepatic volume and function. The beneficial role of additional transcatheter arterial embolization performed after inadequate response to preoperative transhepatic portal vein embolization is described.
Four patients underwent both preoperative transhepatic portal vein embolization and transcatheter arterial embolization, and 6 control patients underwent preoperative transhepatic portal vein embolization only. Changes in right liver lobe volume fraction, residual left lobe volume fraction, and prediction score (low-risk, < 45; borderline, 45-55; high-risk > 55); were evaluated.
Preoperative occlusion of right hepatic inflow vessels increased the volume and function of the contralateral lobe where high-risk patients recovered to the borderline zone for major hepatic resection.
背景/目的：术前经肝门静脉栓塞术可能并不总能充分实现对侧肝体积和功能的预期变化。本文描述了在对术前经肝门静脉栓塞术反应不足后进行额外经导管动脉栓塞术的有益作用。
4例患者接受了术前经肝门静脉栓塞术和经导管动脉栓塞术，6例对照患者仅接受了术前经肝门静脉栓塞术。评估右肝叶体积分数、残余左叶体积分数和预测评分（低风险，<45；临界值，45 - 55；高风险，>55）的变化。
1）术前经肝门静脉栓塞术和经导管动脉栓塞术后右肝叶体积变化（术后/术前）为原始水平的0.75倍，而仅术前经肝门静脉栓塞术后，仅为原始水平的0.81倍。2）术前经肝门静脉栓塞术和经导管动脉栓塞术后残余左肝体积变化（术后/术前）为原始水平的1.40倍，而仅术前经肝门静脉栓塞术后仅为原始水平的1.30倍。术前经肝门静脉栓塞术/经导管动脉栓塞术后左肝体积变化比仅术前经肝门静脉栓塞术后更有利。3）术前经肝门静脉栓塞术和经导管动脉栓塞术后预测评分变化（术后/术前）为原始水平的0.81倍。所有高风险患者的预测评分均恢复到临界值或安全区。仅术前经肝门静脉栓塞术后变化（术前/术后）为原始水平的0.87倍。4）所有4例接受术前经肝门静脉栓塞术和经导管动脉栓塞术的患者均成功接受了右肝叶切除术并恢复了正常生活方式。
术前阻断右肝流入血管可增加对侧肝叶的体积和功能，高风险患者恢复到主要肝切除的临界区。
