经动脉与经肝门静脉栓塞诱导选择性肝肥大：猪的一项比较研究

Transarterial versus transhepatic portal vein embolization to induce selective hepatic hypertrophy: a comparative study in swine.

作者信息

Madoff David C, Gupta Sanjay, Pillsbury Edmund P, Kan Zuxing, Tinkey Peggy T, Stephens L Clifton, Ensor Joe E, Hicks Marshall E, Wright Kenneth C

机构信息

John S Dunn Center for Radiological Sciences, Division of Diagnostic Imaging, Interventional Radiology Section, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA.

出版信息

J Vasc Interv Radiol. 2007 Jan;18(1 Pt 1):79-93. doi: 10.1016/j.jvir.2006.10.018.

DOI:10.1016/j.jvir.2006.10.018

PMID:17296708

Abstract

PURPOSE

Portal vein embolization (PVE) is used to induce liver hypertrophy for surgical candidates with marginal future liver remnant (FLR) volumes. We compared the feasibility, safety, and effectiveness of a transarterial approach for PVE (TA-PVE) with those of a transhepatic approach for PVE (TH-PVE) in a swine model.

MATERIALS AND METHODS

Ten experimental pigs (TA-PVE, n = 5; TH-PVE, n = 5) and six controls (TA, n = 3; TH, n = 3) were studied. For TA-PVE, a microcatheter was advanced into arteries supplying the left and left middle hepatic lobes. A 3 to 1 Ethiodol-ethanol mixture was infused into selected arteries to cross the arterioportal peribiliary plexus and remain within the portal veins (PVs). For TH-PVE, PVs in the same lobar distribution were embolized with 355- to 500-micro m polyvinyl alcohol particles and coils. Controls were similarly catheterized for saline infusion. Computed tomography with volumetry was performed before and 7, 14, 21, and 28 days after PVE to assess FLR hypertrophy (absolute FLR volume change and FLR/total liver volume [TLV]). Computed tomographic volumetry, laboratory data, and histopathology were compared between groups.

RESULTS

All procedures were technically successful. The increases in mean absolute FLR volume (TA-PVE, 148 +/- 84 cm(3); TH-PVE, 62 +/- 19 cm(3); P = .082), mean FLR hypertrophy (TA-PVE, 93.2%; TH-PVE, 48.4%; P = .178), and mean FLR/TLV (TA-PVE, 31.0%; TH-PVE, 16.2%; P = .130) from day 0 to day 28 between experimental groups were better for TA-PVE. Changes in laboratory data among all groups were minimal. Two complications occurred from TA-PVE (right gastric artery embolization [n = 2] without sequela) and two from TH-PVE (acute segmental right PV thrombosis [n = 1]; death 3 weeks after PVE of unknown cause [n = 1]).

CONCLUSIONS

Transarterial portal vein embolization is feasible, safe, and effective for inducing future liver remnant hypertrophy in swine and may represent an improvement over previously reported transhepatic portal vein embolization methods.

摘要

目的

门静脉栓塞术（PVE）用于诱导未来肝残余量（FLR）处于临界值的手术候选者的肝脏肥大。我们在猪模型中比较了经动脉途径门静脉栓塞术（TA-PVE）与经肝途径门静脉栓塞术（TH-PVE）的可行性、安全性和有效性。

材料与方法

研究了10只实验猪（TA-PVE组，n = 5；TH-PVE组，n = 5）和6只对照猪（TA组，n = 3；TH组，n = 3）。对于TA-PVE，将微导管推进至供应左肝叶和左中叶的动脉。将3:1的碘油-乙醇混合物注入选定动脉，使其穿过动脉门静脉周围胆管丛并保留在门静脉（PV）内。对于TH-PVE，用355至500微米的聚乙烯醇颗粒和弹簧圈栓塞相同叶分布的门静脉。对照组同样进行导管插入术以输注生理盐水。在PVE前以及PVE后7、14、21和28天进行容积计算机断层扫描，以评估FLR肥大情况（绝对FLR体积变化和FLR/全肝体积[TLV]）。比较各组之间的计算机断层扫描容积测量、实验室数据和组织病理学结果。

结果

所有操作在技术上均获成功。从第0天到第28天，实验组之间平均绝对FLR体积的增加（TA-PVE组，148±84 cm³；TH-PVE组，62±19 cm³；P = 0.082）、平均FLR肥大（TA-PVE组，93.2%；TH-PVE组，48.4%；P = 0.178）以及平均FLR/TLV（TA-PVE组，31.0%；TH-PVE组，16.2%；P = 0.130），TA-PVE组表现更佳。所有组的实验室数据变化极小。TA-PVE发生了2例并发症（右胃动脉栓塞[n = 2]，无后遗症），TH-PVE发生了2例并发症（急性节段性右PV血栓形成[n = 1]；PVE后3周因不明原因死亡[n = 1]）。