Kubo Shoji, Shiomi Susumu, Tanaka Hiromu, Shuto Taichi, Takemura Shigekazu, Mikami Shinichi, Uenishi Takahiro, Nishino Yoshihiro, Hirohashi Kazuhiro, Kawamura Etsushi, Kinoshita Hiroaki
Department of Gastroenterological and Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Japan.
J Surg Res. 2002 Sep;107(1):113-8. doi: 10.1006/jsre.2002.6503.
Preoperative percutaneous transhepatic portal vein embolization (PTPE) increases the safety of liver resection and improves the outcome after surgery for hepatocellular carcinoma. Scintigraphy with (99m)Tc-galactosyl human serum albumin (GSA) causes specific binding to viable hepatocytes and serves as an index of liver function.
(99m)Tc-GSA scintigraphy was performed before and 2 weeks after PTPE of the right portal vein in 16 patients. The total receptor index, reflecting overall liver function, right receptor index (right lobe), and left receptor index (left lobe) were calculated.
After PTPE, the proportion of the volume of the nonembolized lobe (left lobe) increased (P = 0.0002). The total receptor index slightly decreased after PTPE (P = 0.090), the right receptor index decreased (P < 0.0001), and the left receptor index increased (P < 0.0001). The average increase rate in the left receptor index was 30% of the pre-PTPE value. In 2 patients with portal hypertension (> or =30 cm H(2)O) after PTPE, the left receptor index did not change. In 4 patients whose left receptor index after PTPE (including the 2 patients with portal hypertension) was <0.35, right lobectomy was not performed.
(99m)Tc-GSA scintigraphy demonstrated that PTPE induces a shift in hepatic function from the embolized part to the nonembolized part of the liver. PTPE of the right portal vein increases the hepatic functional reserve of the left lobe as well as its volume. The changes in (99m)Tc-GSA uptake following PTPE may predict the response to liver resection.
术前经皮经肝门静脉栓塞术（PTPE）可提高肝切除术的安全性，并改善肝细胞癌手术后的预后。用（99m）锝-半乳糖基人血清白蛋白（GSA）进行闪烁扫描可使药物与存活的肝细胞特异性结合，并作为肝功能指标。
对16例患者在右门静脉PTPE术前及术后2周进行（99m）Tc-GSA闪烁扫描。计算反映整体肝功能的总受体指数、右受体指数（右叶）和左受体指数（左叶）。
PTPE术后，未栓塞叶（左叶）的体积比例增加（P = 0.0002）。PTPE术后总受体指数略有下降（P = 0.090），右受体指数下降（P < 0.0001），左受体指数增加（P < 0.0001）。左受体指数的平均增加率为PTPE术前值的30%。2例PTPE术后门静脉高压（≥30 cm H₂O）患者的左受体指数未改变。4例PTPE术后（包括2例门静脉高压患者）左受体指数<0.35的患者未进行右叶切除术。
（99m）Tc-GSA闪烁扫描显示PTPE可导致肝功能从肝脏栓塞部分向未栓塞部分转移。右门静脉PTPE可增加左叶的肝功能储备及其体积。PTPE后（99m）Tc-GSA摄取的变化可能预测肝切除的反应。
