经皮经肝门静脉栓塞术联合氰基丙烯酸正丁酯胶优于其他材料：系统评价和荟萃分析。
Portal vein embolization with N-butyl cyanoacrylate glue is superior to other materials: a systematic review and meta-analysis.
机构信息
Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
出版信息
Eur Radiol. 2021 Aug;31(8):5464-5478. doi: 10.1007/s00330-020-07685-w. Epub 2021 Jan 26.
OBJECTIVES
It remains uncertain which embolization material is best for portal vein embolization (PVE). We investigated the various materials for effectiveness in inducing future liver remnant (FLR) hypertrophy, technical and growth success rates, and complication and resection rates.
METHODS
A systematic review from 1998 to 2019 on embolization materials for PVE was performed on Pubmed, Embase, and Cochrane. FLR growth between the two most commonly used materials was compared in a random effects meta-analysis. In a separate analysis using local data (n = 52), n-butyl cyanoacrylate (NBCA) was compared with microparticles regarding costs, radiation dose, and procedure time.
RESULTS
In total, 2896 patients, 61.0 ± 4.0 years of age and 65% male, from 51 papers were included in the analysis. In 61% of the patients, either NBCA or microparticles were used for embolization. The remaining were treated with ethanol, gelfoam, or sclerosing agents. The FLR growth with NBCA was 49.1% ± 29.7 compared to 42.2% ± 40 with microparticles (p = 0.037). The growth success rate with NBCA vs microparticles was 95.3% vs 90.7% respectively (p < 0.001). There were no differences in major complications between NBCA and microparticles. In the local analysis, NBCA (n = 41) entailed shorter procedure time and reduced fluoroscopy time (p < 0.001), lower radiation exposure (p < 0.01), and lower material costs (p < 0.0001) than microparticles (n = 11).
CONCLUSION
PVE with NBCA seems to be the best choice when combining growth of the FLR, procedure time, radiation exposure, and costs.
KEY POINTS
• The meta-analysis shows that n-butyl cyanoacrylate (NBCA) is superior to microparticles regarding hypertrophy of the future liver remnant, 49.1% ± 29.7 vs 42.2% ± 40.0 (p = 0.037). • There is no significant difference in major complication rates for portal vein embolization using NBCA, 4% (24/681), compared with microparticles, 5% (25/494) (p > 0.05). • Local data shows a shorter procedure time, 215 vs 348 mins from arrival to departure at the interventional radiology unit, and fluoroscopy time, 43 vs 96 mins (p < 0.001), lower radiation dosage, 573 vs 1287 Gycm (p < 0.01), and costs, €816 vs €4233 (p < 0.0001) for NBCA compared to microparticles.
目的
目前尚不确定哪种栓塞材料最适合门静脉栓塞术（PVE）。我们研究了各种材料在诱导未来肝残留（FLR）肥大、技术和生长成功率以及并发症和切除率方面的效果。
方法
对 1998 年至 2019 年 PVE 栓塞材料的系统评价在 Pubmed、Embase 和 Cochrane 上进行。使用随机效应荟萃分析比较两种最常用材料之间的 FLR 生长情况。在使用本地数据（n=52）的单独分析中，将 n-丁基氰基丙烯酸酯（NBCA）与微球进行了比较，比较了成本、辐射剂量和手术时间。
结果
共纳入 51 篇文献中的 2896 例患者，年龄 61.0±4.0 岁，男性占 65%。61%的患者采用 NBCA 或微球进行栓塞治疗。其余患者接受乙醇、明胶海绵或硬化剂治疗。NBCA 组的 FLR 生长率为 49.1%±29.7%，微球组为 42.2%±40%（p=0.037）。NBCA 组与微球组的生长成功率分别为 95.3%和 90.7%（p<0.001）。NBCA 与微球之间在主要并发症方面无差异。在本地分析中，NBCA（n=41）的手术时间和透视时间更短（p<0.001），辐射暴露更低（p<0.01），材料成本更低（p<0.0001），而微球（n=11）。
结论
在综合考虑 FLR 生长、手术时间、辐射暴露和成本的情况下，PVE 中使用 NBCA 似乎是最佳选择。
关键点
荟萃分析显示，n-丁基氰基丙烯酸酯（NBCA）在肝残留肥大方面优于微球，49.1%±29.7% vs 42.2%±40.0%（p=0.037）。
使用 NBCA 与微球相比，门静脉栓塞的主要并发症发生率无显著差异，分别为 4%（24/681）和 5%（25/494）（p>0.05）。
本地数据显示，NBCA 的手术时间更短，从到达介入放射科到离开的时间为 215 分钟，而透视时间为 43 分钟，而微球分别为 348 分钟和 96 分钟（p<0.001），辐射剂量更低，NBCA 为 573 Gycm，而微球为 1287 Gycm（p<0.01），成本更低，NBCA 为 816 欧元，微球为 4233 欧元（p<0.0001）。
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