Kaido Toshimi, Arii Shigeki, Shimada Yutaka, Mori Akira, Imamura Masayuki
Department of Surgery and Surgical Basic Science, Kyoto University School of Medicine, Kyoto, Japan.
Hepatogastroenterology. 2003 Jan-Feb;50(49):140-5.
BACKGROUND/AIMS: The aim of this study was to investigate the hypertrophic effect of portal embolization in various types of liver and clarify useful variables, for predicting efficacy of portal embolization.
Portal embolization was performed for 46 patients with hepatocellular carcinoma (n = 30), biliary tract cancer (n = 9), or metastatic liver tumors (n = 7). The hypertrophic effect of portal embolization in relation to diseases, clinical liver conditions, histological fibrosis, and liver function were examined.
The hypertrophic effect of portal embolization was impaired in the patients with hepatocellular carcinoma, chronic hepatitis/cirrhotic liver, and advanced liver fibrosis. ICGR15 (indocyanine green dye retention rate at 15 minutes) was revealed to be an independent adverse predicting factor. Especially in hepatocellular carcinoma patients, platelet count was significantly correlated with the hypertrophy ratio. In patients who underwent major hepatectomy for hepatocellular carcinoma, not only the incidences of posthepatectomy liver failure but also survival rate were similar between patients with and without portal embolization, although patients with portal embolization originally had a limited liver function.
Preoperative portal embolization made major hepatectomy possible in hepatocellular carcinoma patients, although portal embolization was less effective compared with other diseases. ICGR15 and platelet count may be novel variables to predict the hypertrophic effect of portal embolization in all and hepatocellular carcinoma patients, respectively.
背景/目的：本研究旨在探讨门静脉栓塞术对不同类型肝脏的肥大效应，并阐明有助于预测门静脉栓塞术疗效的变量。
对46例肝细胞癌患者（n = 30）、胆管癌患者（n = 9）或肝转移瘤患者（n = 7）实施门静脉栓塞术。研究了门静脉栓塞术在疾病、临床肝脏状况、组织学纤维化及肝功能方面的肥大效应。
门静脉栓塞术的肥大效应在肝细胞癌、慢性肝炎/肝硬化及重度肝纤维化患者中受损。吲哚菁绿15分钟滞留率（ICGR15）被证实为一个独立的不良预测因素。尤其是在肝细胞癌患者中，血小板计数与肥大率显著相关。对于接受肝细胞癌肝大部切除术的患者，尽管接受门静脉栓塞术的患者原本肝功能有限，但有无门静脉栓塞术患者的肝切除术后肝衰竭发生率及生存率相似。
术前门静脉栓塞术使肝细胞癌患者实施肝大部切除术成为可能，尽管与其他疾病相比门静脉栓塞术效果较差。ICGR15和血小板计数可能分别是预测所有患者及肝细胞癌患者门静脉栓塞术肥大效应的新变量。
