Takei Ryoji, Ubara Yoshifumi, Hoshino Junichi, Higa Yasushi, Suwabe Tatsuya, Sogawa Yoko, Nomura Kazufumi, Nakanishi Shohei, Sawa Naoki, Katori Hideyuki, Takemoto Fumi, Hara Shigeko, Takaichi Kenmei
Department of Radiology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan.
Am J Kidney Dis. 2007 Jun;49(6):744-52. doi: 10.1053/j.ajkd.2007.03.018.
We have achieved renal contraction therapy in patients with autosomal dominant polycystic kidney disease (ADPKD) by means of renal transcatheter arterial embolization (TAE) using intravascular coils, decreasing renal size and improving quality of life in almost all patients. We presently perform hepatic TAE in patients with intractable symptomatic polycystic liver.
Uncontrolled trial.
SETTING & PARTICIPANTS: 30 patients with ADPKD referred for arteriography to an academic medical center. 22 patients had kidney failure treated by means of dialysis.
We embolized arteries supplying hepatic segments replaced by cysts that were associated with well-developed hepatic arteries, but obstructed intrahepatic portal veins.
OUTCOMES & MEASUREMENTS: Various volumes before and after TAE were compared by using computed tomography and National Institutes of Health Image software in 30 patients with follow-up computed tomography 18 to 37 months after therapy.
Total liver volume and total intrahepatic cyst volume decreased from 7,882 +/- 2,916 and 6,677 +/- 2,978 to 6,041 +/- 2,282 and 4,625 +/- 2,299 cm(3), respectively (P < 0.0001 for both). Fractions of remaining (FR) total liver volume and FR of intrahepatic cyst volume were 78.8% +/- 17.6% and 70.4% +/- 20.9%, respectively. Hepatic parenchyma increased from 1,205 +/- 250 to 1,406 +/- 277 cm(3) (P = 0.0004). In 29 of 30 patients, both total liver volume and intrahepatic cyst volume decreased; in 1 patient, total liver volume increased from 5,755 to 7,069 cm(3), whereas cysts enlarged from 4,500 to 5,531 cm(3). No serious complications were experienced. In 24 patients, the post-TAE course was favorable. TAE failed to benefit 6 patients because of unrelated hepatic infection, peritonitis, hepatic failure, acute leukemia, or pelvic fracture.
Absence of a control group.
TAE may be an option for patients with ADPKD with symptomatic polycystic liver who are not candidates for surgical treatment.
我们通过使用血管内线圈进行肾动脉导管栓塞术（TAE），在常染色体显性多囊肾病（ADPKD）患者中实现了肾缩小治疗，几乎所有患者的肾脏大小均减小，生活质量得到改善。我们目前对有症状的难治性多囊肝患者进行肝TAE治疗。
非对照试验。
30例因血管造影转诊至学术医学中心的ADPKD患者。22例患者通过透析治疗肾衰竭。
我们栓塞了由囊肿替代的肝段的供血动脉，这些囊肿与发育良好的肝动脉相关，但肝内门静脉受阻。
在30例患者中，在治疗后18至37个月进行随访CT检查，使用计算机断层扫描和美国国立卫生研究院图像软件比较TAE前后的各种体积。
肝脏总体积和肝内囊肿总体积分别从7,882±2,916和6,677±2,978降至6,041±2,282和4,625±2,299 cm³（两者P均<0.0001）。剩余肝脏总体积分数（FR）和肝内囊肿体积分数分别为78.8%±17.6%和70.4%±20.9%。肝实质从1,205±250增加至1,406±277 cm³（P = 0.0004）。30例患者中有29例肝脏总体积和肝内囊肿体积均减小；1例患者肝脏总体积从5,755增加至7,069 cm³，而囊肿从4,500增大至5,531 cm³。未发生严重并发症。24例患者TAE后的病程良好。6例患者因无关的肝感染、腹膜炎、肝衰竭、急性白血病或骨盆骨折，TAE未使其受益。
缺乏对照组。
对于有症状的多囊肝且不适合手术治疗的ADPKD患者，TAE可能是一种选择。
