Mine Takahiko, Murata Satoru, Ueda Tatsuo, Takeda Minako, Onozawa Shiro, Yamaguchi Hidenori, Kawano Youichi, Kumita Shin-Ichiro
Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan.
J Gastroenterol Hepatol. 2014;29(7):1515-21. doi: 10.1111/jgh.12571.
To retrospectively evaluate proper hepatic artery embolization, with respect to the development of extrahepatic collaterals.
Proper hepatic artery embolization was performed in 18 patients with hemorrhagic arterial lesions in the hepatic hilum. Post-procedural development of extrahepatic collaterals was evaluated by computed tomography or angiography. Embolization data and liver function tests were assessed. The correlation of outcomes with portal venous stenosis, hepatic failure prior to embolization, elevation of prothrombin time, and insufficient collateral development were analyzed.
Postoperative bleeding occurred in 17/18 patients, and one was treated for an idiopathic aneurysm of the proper hepatic artery; all treatments achieved technical success. Extrahepatic collaterals were confirmed in 13 patients. Elevations of liver function test values were transient and returned to baseline within 14 days in patients with collateral development (n = 13), but were unimproved in patients without collaterals (n = 5) (P < 0.001). Portal venous stenosis; prior hepatic failure; unrecovered, elevation of prothrombin time; and insufficient collateral development were significantly correlated with poor outcomes (P < 0.05, respectively).
Proper hepatic artery embolization is effective for hemostasis, and extrahepatic collateral development is expected. Therefore, this is a safe treatment without prolonged hepatic ischemic damage, especially in patients without severe portal venous stenosis or prior hepatic failure.
回顾性评估肝固有动脉栓塞术与肝外 collateral 形成的关系。
对 18 例肝门部动脉出血性病变患者实施肝固有动脉栓塞术。术后通过计算机断层扫描或血管造影评估肝外 collateral 的形成情况。评估栓塞数据和肝功能检查结果。分析预后与门静脉狭窄、栓塞术前肝功能衰竭、凝血酶原时间升高及 collateral 形成不足之间的相关性。
18 例患者中有 17 例术后出血，1 例因肝固有动脉特发性动脉瘤接受治疗；所有治疗均取得技术成功。13 例患者证实有肝外 collateral 形成。肝功能检查值升高为一过性，有 collateral 形成的患者（n = 13）在 14 天内恢复至基线水平，但无 collateral 形成的患者（n = 5）未改善（P < 0.001）。门静脉狭窄、既往肝功能衰竭、凝血酶原时间未恢复正常及 collateral 形成不足与不良预后显著相关（P 均 < 0.05）。
肝固有动脉栓塞术止血效果良好，有望形成肝外 collateral。因此，这是一种安全的治疗方法，不会造成长时间的肝缺血损伤，尤其是对于无严重门静脉狭窄或既往肝功能衰竭的患者。
