Luz José Hugo Mendes, Luz Paula Mendes, Bilhim Tiago, Martin Henrique Salas, Gouveia Hugo Rodrigues, Coimbra Élia, Gomes Filipe Veloso, Souza Roberto Romulo, Faria Igor Murad, de Miranda Tiago Nepomuceno
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil.
National Institute of Infectious Disease EvandroChagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Cancer Imaging. 2017 Sep 20;17(1):25. doi: 10.1186/s40644-017-0127-3.
To evaluate the efficacy of portal vein embolization (PVE) with n-Butyl-cyanoacrylate (NBCA) through an ipsilateral approach before major hepatectomy. Secondary end-points were PVE safety, liver resection and patient outcome.
Over a 5-year period 50 non-cirrhotic consecutive patients were included with primary or secondary liver cancer treatable by hepatectomy with a liver remnant (FLR) volume less than 25% or less than 40% in diseased livers.
There were 37 men and 13 women with a mean age of 57 years. Colorectal liver metastases were the most frequent tumor and patients were previously exposed to chemotherapy. FLR increased from 422 ml to 629 ml (P < 0.001) after PVE, corresponding to anincrease of 52%. The FLR ratio increased from 29.6% to 42.3% (P < 0.001). Kinetic growth rate was 2.98%/week. A negative association was observed between increase in the FLR and FLR ratio and FLR volume before PVE (P = 0.002). In 31 patients hepatectomy was accomplished and only one patient presented with liver insufficiency within 30 days after surgery.
PVE with NBCA through an ipsilateral puncture is effective before major hepatectomy. Meticulous attention is needed especially near the end of the embolization procedure to avoid complications.
Clinical Study ISRCTN registration number: ISRCTN39855523 . Registered March 13th 2017.
评估在大型肝切除术前通过同侧入路使用正丁基氰基丙烯酸酯（NBCA）进行门静脉栓塞（PVE）的疗效。次要终点为PVE安全性、肝切除情况及患者预后。
在5年期间，纳入50例非肝硬化的连续患者，这些患者患有原发性或继发性肝癌，可通过肝切除术治疗，且剩余肝脏（FLR）体积小于25%，或患病肝脏中FLR体积小于40%。
患者中男性37例，女性13例，平均年龄57岁。结直肠癌肝转移是最常见的肿瘤类型，且患者此前均接受过化疗。PVE后FLR从422 ml增加至629 ml（P < 0.001），增幅为52%。FLR比率从29.6%增至42.3%（P < 0.001）。动力学生长率为2.98%/周。观察到PVE前FLR及FLR比率的增加与FLR体积呈负相关（P = 0.002）。31例患者完成了肝切除术，术后30天内仅1例患者出现肝功能不全。
在大型肝切除术前，通过同侧穿刺使用NBCA进行PVE是有效的。在栓塞过程接近尾声时尤其需要密切关注，以避免并发症。
临床研究ISRCTN注册号：ISRCTN39855523。于2017年3月13日注册。
