Tanaka H, Kinoshita H, Hirohashi K, Kubo S, Fujio N, Iwasa R, Lee K C
Second Department of Surgery, Osaka City University Medical School, Japan.
Nihon Geka Gakkai Zasshi. 1992 Oct;93(10):1317-23.
The usefulness of preoperative percutaneous transhepatic portal vein embolization (PTPE) in extending the indications for hepatectomy and increasing the safety of extended hepatectomy for hepatocellular carcinoma was studied in 21 patients who underwent right hepatic lobectomy with PTPE of the right first portal branch (group E), in 15 such patients but without PTPE (group N), and in seven such patients who underwent PTPE at this location but could not undergo surgery (group U). The mean volume of the left lobe increased but the results of a 15-minute indocyanine green retention test were worsened 2 weeks after PTPE and again 4 weeks after hepatectomy, but these changes after hepatectomy were almost the same in groups E and N. The worsening of liver function and coagulation test results was less in group E than in group N. The mean prognosis score was better in group E two weeks after PTPE than before, but not in group U. The four patients in group E with high portal vein pressure (> or = 30 cmH2O) or a high prognosis score (> or = 50 points) after PTPE developed hepatic failure after surgery. Preoperative PTPE was useful in extending the indications for hepatectomy and increasing the safety of extended hepatectomy. Evaluation of the clinical course after PTPE was also useful when decisions about the operative method to be used were being made.
对21例行右肝叶切除术并经皮经肝门静脉栓塞（PTPE）右第一门静脉分支的患者（E组）、15例同样行右肝叶切除术但未行PTPE的患者（N组）以及7例在此部位行PTPE但无法接受手术的患者（U组）进行研究，以探讨术前经皮经肝门静脉栓塞术在扩大肝癌肝切除术适应证及提高扩大肝切除术安全性方面的作用。PTPE术后2周左叶平均体积增大，但吲哚菁绿15分钟潴留试验结果恶化，肝切除术后4周再次恶化，但E组和N组肝切除术后的这些变化几乎相同。E组肝功能和凝血试验结果的恶化程度低于N组。PTPE术后2周E组平均预后评分较术前改善，但U组未改善。E组中4例PTPE后门静脉压力高（≥30 cmH2O）或预后评分高（≥50分）的患者术后发生肝衰竭。术前PTPE有助于扩大肝切除术适应证并提高扩大肝切除术的安全性。在决定采用何种手术方法时，评估PTPE后的临床病程也很有用。
