Hwang Shin, Lee Sung-Gyu, Sung Kyu-Bo, Lee Young-Joo
Division of Hepatopancreatobiliary Surgery, and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
Hepatogastroenterology. 2007 Sep;54(78):1817-20.
Portal vein embolization (PVE) is a preparative procedure to facilitate major hepatectomy. Most patients with various hepatobiliary diseases were tolerable to right PVE. However, a few patients revealed marked deterioration of liver function after PVE, which made surgeons hesitate whether to carry out preplanned major hepatectomy. We report 2 cases of right liver resection after an episode of PVE-induced transient liver failure. The first patient was a 42-year-old male who had hepatocellular carcinoma in the cirrhotic liver background. After right PVE, serum aspartate and alanine aminotransferases raised to 1222 IU/L and 1908 IU/L, respectively. His liver function improved very slowly, and right lobectomy could be performed after waiting of 46 days. Postoperative restoration of liver function was also delayed, but he recovered after all. The second patient was a 53-year-old male with intrahepatic cholangiocarcinoma without jaundice. Serum total bilirubin rose to 10.7 mg/dL after right PVE, and decreased slowly. Right lobectomy was carried out after waiting of 45 days and postoperative course was uneventful. Meticulous liver transection without interruption of hepatic inflow, early infusion of gabexate mesilate, and intraportal infusion of glucose-insulin-potassium solution were adopted to protected the remnant liver. We think that transient liver failure after PVE is not contraindicated for major hepatectomy if there is no definite causal risk factor, but every effort should be paid to prevent posthepatectomy liver failure.
门静脉栓塞术（PVE）是一种促进肝大部切除术的预备性手术。大多数患有各种肝胆疾病的患者对右半肝门静脉栓塞术耐受性良好。然而，少数患者在PVE后肝功能明显恶化，这使得外科医生对于是否进行预先计划的肝大部切除术犹豫不决。我们报告了2例PVE诱发短暂性肝衰竭后行右肝切除术的病例。首例患者为一名42岁男性，在肝硬化肝背景下患有肝细胞癌。右半肝门静脉栓塞术后，血清天冬氨酸转氨酶和丙氨酸转氨酶分别升至1222 IU/L和1908 IU/L。其肝功能恢复非常缓慢，等待46天后才进行右叶切除术。术后肝功能恢复也延迟，但最终他康复了。第二例患者是一名53岁男性，患有无黄疸的肝内胆管癌。右半肝门静脉栓塞术后血清总胆红素升至10.7 mg/dL，并缓慢下降。等待45天后进行了右叶切除术，术后过程顺利。采用精细肝断面技术避免肝血流阻断、早期输注甲磺酸加贝酯以及门静脉内输注葡萄糖 - 胰岛素 - 钾溶液来保护残余肝脏。我们认为，如果没有明确的因果风险因素，PVE后短暂性肝衰竭并非肝大部切除术的禁忌证，但应尽一切努力预防肝切除术后肝衰竭。
