Fischman Aaron M, Ward Thomas J, Horn Jeremy C, Kim Edward, Patel Rahul S, Nowakowski F Scott, Lookstein Robert A
Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
J Vasc Interv Radiol. 2014 Jul;25(7):1045-53. doi: 10.1016/j.jvir.2014.01.034. Epub 2014 Mar 19.
To evaluate the safety and efficacy of portal vein embolization (PVE) with sodium tetradecyl sulfate (STS) foam.
A single-center retrospective review of 35 patients (27 men and 8 women; mean age, 61 y) who underwent PVE with STS foam was performed. The technical success rate, rate of PVE at producing adequate future liver remnant (FLR) hypertrophy, and rate of disease progression precluding resection after PVE were analyzed. Complications of PVE and liver resection after PVE were recorded.
PVE was performed on 35 patients before right hepatic resection for both primary and secondary hepatic malignancies (22 hepatocellular carcinoma, 10 metastasis, 2 cholangiocarcinoma, 1 invasive gallbladder carcinoma). Technical success was achieved in 97.1% (34 of 35) of patients. Mean FLR of the total estimated liver volume increased from 24.5% (SD, 7.7%) to 36.5% (SD, 14.5%), a mean percentage increase of 48.8% (SD, 34.3%). PVE produced adequate FLR hypertrophy in 31 of 35 patients (88.6%). Proposed right hepatectomy was subsequently performed in 27 patients (77.1%). One patient remains scheduled for surgery, two had peritoneal spread at surgery and resection was aborted, two had disease progression on imaging after PVE, and three had inadequate FLR hypertrophy with no surgery. One major complication was observed related to PVE that involved nontarget embolization to segment III, which was managed conservatively.
Preoperative PVE with STS foam is a safe and effective method to induce hypertrophy of the FLR.
评估十四烷基硫酸钠（STS）泡沫进行门静脉栓塞术（PVE）的安全性和有效性。
对35例行STS泡沫PVE的患者（27例男性，8例女性；平均年龄61岁）进行单中心回顾性研究。分析技术成功率、PVE产生足够的未来肝残余（FLR）肥大的比例以及PVE后因疾病进展而无法切除的比例。记录PVE及PVE后肝切除的并发症。
35例患者在右肝切除术前因原发性和继发性肝恶性肿瘤行PVE（22例肝细胞癌，10例转移瘤，2例胆管癌，1例浸润性胆囊癌）。97.1%（35例中的34例）的患者技术成功。总预估肝体积的平均FLR从24.5%（标准差7.7%）增加到36.5%（标准差14.5%），平均增加百分比为48.8%（标准差34.3%）。35例患者中有31例（88.6%）PVE产生了足够的FLR肥大。随后27例患者（77.1%）进行了拟行的右肝切除术。1例患者仍计划手术，2例患者术中出现腹膜播散，手术中止，2例患者PVE后影像学检查显示疾病进展，3例患者FLR肥大不足未行手术。观察到1例与PVE相关的主要并发症，涉及非靶区栓塞至Ⅲ段，经保守治疗。
术前用STS泡沫行PVE是诱导FLR肥大的一种安全有效的方法。
