Doros Attila, Weszelits Viola, Puhl Mária, Fehérvári Imre, Alföldy Ferenc
Semmelweis Egyetem AOK, Transzplantációs és Sebészeti Klinika, 1082 Budapest, Baross u. 23.
Magy Seb. 2003 Feb;56(1):39-44.
Major liver resection cannot be performed when the remaining liver mass is too small. Preoperative embolization of the portal vein (PVE) helps to increase the volume of the non-tumorous liver segments, and patients' liver function will remain stable postoperatively. CT, MRI, CTAP examinations help to decide about surgery. Volume measurements are performed based on data of CT scans. PVE is indicated, when the remaining, non-tumorous liver volume is too small. The procedure starts with percutaneous portal vein catheterization, then selected portal vein branches are embolized with a mixture of contrast material, antibiotics and Gelfoam particles. The patients stay in the hospital 3-5 days after the procedure. Control CT-volumetry is done after 3-6 weeks. From November 2001 to April 2002 3 patients were selected to have this procedure. PVE of the right portal branches were performed successfully in two cases. Control CT-volumetry showed significant increase of the volume of the left liver lobe. One patient underwent successful right hemihepatectomy. On the third patient we could not catheterize the portal vein. PVE is a relatively safe and tolerable procedure. The increased remaining liver volume helps in performing major liver resection.
当剩余肝组织过少时，无法进行大范围肝切除术。术前门静脉栓塞术（PVE）有助于增加非肿瘤肝段的体积，且患者术后肝功能可保持稳定。CT、MRI、CTAP检查有助于确定手术方案。基于CT扫描数据进行体积测量。当剩余的非肿瘤肝体积过小时，需行PVE。该操作始于经皮门静脉插管，然后用造影剂、抗生素和明胶海绵颗粒的混合物栓塞选定的门静脉分支。术后患者需住院3 - 5天。术后3 - 6周进行CT容积测量复查。2001年11月至2002年4月，选取3例患者进行该手术。2例成功进行了右门静脉分支的PVE。CT容积测量复查显示左肝叶体积显著增加。1例患者成功接受了右半肝切除术。第3例患者未能成功进行门静脉插管。PVE是一种相对安全且耐受性良好的手术。剩余肝体积的增加有助于进行大范围肝切除术。
