Korda David Adam, Bibok Andras, Doros Attila, Horvathy Denes, Hahn Oszkar, Kokas Balint, Pekli Damjan, Meltzer Anna Zsofia, Szijarto Attila, Nadasdy-Horvath Domonkos, Deak Pal Akos
Semmelweis University, Department of Interventional Radiology, Határőr út 18, Budapest H-1122, Hungary.
Semmelweis University, Department of Surgery, Transplantation and Gastroenterology, Üllői út 78, Budapest H-1082, Hungary.
Eur J Radiol Open. 2024 Nov 21;13:100613. doi: 10.1016/j.ejro.2024.100613. eCollection 2024 Dec.
In recent years several new techniques have emerged to induce hypertrophy of the future liver remnant prior to major hepatectomies. We aimed to summarize our initial experience with Double-vein Embolization as the first center in Hungary.
Between March 2023 and August 2024 a total of 16 Double-vein Embolization procedures were performed in Semmelweis University. Future liver remnant volume was calculated based on computed tomography scans obtained within 4 weeks prior and 2-3 weeks after the procedure. Tc-99m mebrofenin hepatobiliary scintigraphy results were available for 12/16 patients.
Technical success rate was 100 %. No major complication was observed. Successful resection rate was 93.8 %. One patient died due to post-hepatectomy liver failure. Future liver remnant volume and ratio increased significantly after the procedure compared to baseline (433.1 ± 163.8 cm vs. 603.5 ± 201.8 cm, p < 0.0001 and 27.2 ± 6.5 % vs. 37 ± 8.8 %, p < 0.0001, respectively). Future liver remnant clearance improved significantly 1 and 2 weeks after the procedure (1.68 ± 0.58 %/min/m vs. 2.44 ± 0.64 %/min/m and 2.39 ± 0.31 %/min/m, respectively). Mean function gain was 50.6 % after one week and 60.1% after two weeks, respectively.
Volumetric and functional outcomes in the present study are comparable with results reported in the literature. Our findings provide further evidence that Double-vein Embolization is a safe procedure that offers sufficient volumetric and functional gain in most candidates for liver resection. However, further studies are needed to define the exact place of this new technique in clinical practice.
近年来，出现了几种新技术，用于在进行大型肝切除术前诱导未来肝残余体积增大。我们旨在总结作为匈牙利首个中心开展双静脉栓塞术的初步经验。
2023年3月至2024年8月期间，塞梅尔维斯大学共进行了16例双静脉栓塞术。根据术前4周内及术后2 - 3周获得的计算机断层扫描结果计算未来肝残余体积。16例患者中有12例可获得锝-99m美布芬宁肝胆闪烁显像结果。
技术成功率为100%。未观察到重大并发症。成功切除率为93.8%。1例患者因肝切除术后肝功能衰竭死亡。与基线相比，术后未来肝残余体积和比例显著增加（分别为433.1±163.8立方厘米对603.5±201.8立方厘米，p<0.0001；27.2±6.5%对37±8.8%，p<0.0001）。术后1周和2周，未来肝残余清除率显著提高（分别为1.68±0.58%/分钟/立方米对2.44±0.64%/分钟/立方米和2.39±0.31%/分钟/立方米）。平均功能增益在1周后为50.6%，2周后为60.1%。
本研究中的体积和功能结果与文献报道的结果相当。我们的研究结果进一步证明，双静脉栓塞术是一种安全的手术，在大多数肝切除候选患者中能提供足够的体积和功能增益。然而，需要进一步研究来确定这项新技术在临床实践中的确切地位。
