Department of Radiology, St-Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France.
INSERM U896, Montpellier Cancer Research Institute, 34298, Montpellier, France.
Eur Radiol. 2016 Dec;26(12):4259-4267. doi: 10.1007/s00330-016-4291-9. Epub 2016 Apr 18.
To assess technical feasibility, safety, and efficacy of the liver venous deprivation (LVD) technique that combines both portal and hepatic vein embolization during the same procedure for liver preparation before major hepatectomy.
Seven patients (mean age:63.6y[42-77y]) underwent trans-hepatic LVD for liver metastases (n = 2), hepatocellular carcinoma (n = 1), intrahepatic cholangiocarcinoma (n = 3) and Klatskin tumour (n = 1). Assessment of future remnant liver (FRL) volume, liver enzymes and histology was performed.
Technical success was 100 %. No complication occurred before surgery. Resection was performed in 6/7 patients. CT-scan revealed hepatic congestion in the venous-deprived area (6/7 patients). A mean of 3 days (range: 1-8 days) after LVD, transaminases increased (AST: from 42 ± 24U/L to 103 ± 118U/L, ALT: from 45 ± 25U/L to 163 ± 205U/L). Twenty-three days (range: 13-30 days) after LVD, FRL increased from 28.2 % (range: 22.4-33.3 %) to 40.9 % (range: 33.6-59.3 %). During the first 7 days, venous-deprived liver volume increased (+13.4 %) probably reflecting vascular congestion, whereas it strongly decreased (-21.3 %) at 3-4 weeks. Histology (embolized lobe) revealed sinusoidal dilatation, hepatocyte necrosis and important atrophy in all patients.
Trans-hepatic LVD technique is feasible, well tolerated and provides fast and important hypertrophy of the FRL. This new technique needs to be further evaluated and compared to portal vein embolization.
• Twenty-three days after LVD, FRL increased from 28.2 % (range:22.4-33.3 %) to 40.9 % (range:33.6-59.3 %) • During the first 7 days, venous-deprived liver volume increased (+13.4 %) • Venous-deprived liver volume strongly decreased (mean atrophy:229 cc; -21.3 %) at 3-4 weeks • Histology of venous-deprived liver revealed sinusoidal dilatation, hepatocyte necrosis and important atrophy.
评估联合门静脉和肝静脉栓塞的肝静脉阻断（LVD）技术在大肝切除前肝脏准备中的技术可行性、安全性和疗效。
7 名患者（平均年龄：63.6 岁[42-77 岁]）接受经肝 LVD 治疗肝转移（n=2）、肝细胞癌（n=1）、肝内胆管癌（n=3）和 Klatskin 肿瘤（n=1）。评估未来残留肝（FRL）体积、肝功能和组织学。
技术成功率为 100%。手术前无并发症发生。7 例中有 6 例进行了切除术。CT 扫描显示静脉阻断区肝充血（6/7 例）。LVD 后平均 3 天（范围：1-8 天），转氨酶升高（AST：从 42±24U/L 增加至 103±118U/L，ALT：从 45±25U/L 增加至 163±205U/L）。LVD 后 23 天（范围：13-30 天），FRL 从 28.2%（范围：22.4-33.3%）增加到 40.9%（范围：33.6-59.3%）。在最初的 7 天内，静脉阻断肝体积增加（+13.4%），可能反映了血管充血，而在 3-4 周时则明显减少（-21.3%）。所有患者的肝组织学（栓塞叶）均显示窦状扩张、肝细胞坏死和重要萎缩。
经肝 LVD 技术是可行的，耐受性良好，并能快速、显著地增加 FRL 体积。这项新技术需要进一步评估，并与门静脉栓塞进行比较。
LVD 后 23 天，FRL 从 28.2%（范围：22.4-33.3%）增加到 40.9%（范围：33.6-59.3%）
在最初的 7 天内，静脉阻断肝体积增加（+13.4%）
静脉阻断肝体积在 3-4 周时明显减少（平均萎缩：229cc；-21.3%）
静脉阻断肝的组织学显示窦状扩张、肝细胞坏死和重要萎缩
