Lunardi Alessandro, Cervelli Rosa, Volterrani Duccio, Vitali Saverio, Lombardo Carlo, Lorenzoni Giulia, Crocetti Laura, Bargellini Irene, Campani Daniela, Pollina Luca Emanuele, Cioni Roberto, Caramella Davide, Boggi Ugo
Division of Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
Division of Nuclear Medicine, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Cardiovasc Intervent Radiol. 2018 May;41(5):789-798. doi: 10.1007/s00270-018-1882-7. Epub 2018 Jan 22.
To assess the feasibility of radiological stage-1 ALPPS, associating liver partition and portal vein ligation for staged hepatectomy, by combining portal vein embolization (PVE) with percutaneous intrahepatic split by ablation (PISA).
Three patients (mean age 65.0 ± 7.3 years) underwent PVE and PISA. PISA was performed 21 days after PVE by microwave ablation to create a continuous intrahepatic cutting plane. Abdominal CT examinations were performed before and after PVE and PISA. The future liver remnant (FLR) volume was calculated by semiautomatic segmentation, and increase was reported as a percentage of the pre-procedural volume. The FLR/body weight (FLR/BW) ratio was calculated; a ratio greater than 0.8% was considered sufficient for guaranteeing adequate liver function after surgery. The liver function before and after PISA was also evaluated by 99mTc-mebrofenin hepatobiliary scintigraphy. Patients' laboratory tests, performance status, ability to walk were assessed before and after PVE and PISA procedures.
No procedure-related complications were recorded. The FLR volume increase in each patient was 42.0, 33.1 and 30.4% within 21 days of PVE and 109.3, 68.1 and 71.7% within 10 days after PISA. The FLR/BW ratios were 0.76, 0.66, 0.63% and 1.13, 0.83, 0.83% after PVE and PISA procedures, respectively. Two patients underwent successful right hepatectomy; in one patient, despite 1.13% FLR/BW, surgery was not performed because of the absolute rejection of blood transfusion due to the patient's religious convictions.
Radiological stage-1 ALPPS is a feasible, minimally invasive option to be further investigated to become an effective alternative to surgical stage-1 ALPPS.
通过将门静脉栓塞术（PVE）与经皮肝内消融劈开术（PISA）相结合，评估放射学一期ALPPS（联合肝脏分隔与门静脉结扎的分期肝切除术）的可行性。
3例患者（平均年龄65.0±7.3岁）接受了PVE和PISA。PISA在PVE后21天进行，通过微波消融创建连续的肝内切割平面。在PVE和PISA前后进行腹部CT检查。通过半自动分割计算未来肝残余（FLR）体积，并将增加量报告为术前体积的百分比。计算FLR/体重（FLR/BW）比值；比值大于0.8%被认为足以保证术后有足够的肝功能。还通过99mTc-美布芬宁肝胆闪烁显像评估PISA前后的肝功能。在PVE和PISA操作前后评估患者的实验室检查、体能状态、行走能力。
未记录到与操作相关的并发症。每位患者在PVE后21天内FLR体积增加分别为42.0%、33.1%和30.4%，在PISA后10天内分别为109.3%、68.1%和71.7%。PVE和PISA操作后，FLR/BW比值分别为0.76%、0.66%、0.63%和1.13%、0.83%、0.83%。2例患者成功进行了右半肝切除术；1例患者尽管FLR/BW为1.13%，但由于患者宗教信仰绝对拒绝输血，未进行手术。
放射学一期ALPPS是一种可行的微创选择，有待进一步研究以成为手术一期ALPPS有效的替代方案。
