Zieren J, Büttemeyer R, Müller J M
Klinik und Poliklinik für Chirurgie der Charité, Humboldt-Universität Berlin.
Chirurg. 1998 Jun;69(6):639-41. doi: 10.1007/s001040050468.
Hepatic involvement in hereditary hemorrhagic telangiectasia (HHT) is rare. Among local pathologic alterations like fibrosis and cirrhosis, arteriovenous shunts lead to hypercirculatory heart failure and require efficient therapy. Present therapeutic strategies consist of percutaneous selective embolization or complete ligation of the hepatic artery. We describe a 53-year-old woman with HHT in whom percutaneous selective embolization of the left hepatic artery failed because of unfavorable anatomy. Instead of ligation a new method of adjustable banding of the hepatic artery was tested. After small-incision laparotomy an expander prosthesis was put on the proper hepatic artery. By filling the prosthesis via the implanted port system the hepatic perfusion could be reduced under control. This method led to effective reduction of the liver perfusion and heart time volume and to successful treatment of heart failure. The method described is an alternative treatment to ligation of the hepatic artery in cases in which percutaneous embolization failed or is not possible.
肝脏受累于遗传性出血性毛细血管扩张症（HHT）较为罕见。在诸如纤维化和肝硬化等局部病理改变中，动静脉分流会导致高循环性心力衰竭，需要有效的治疗方法。目前的治疗策略包括经皮选择性栓塞或肝动脉完全结扎。我们描述了一名53岁患有HHT的女性，其左肝动脉经皮选择性栓塞因解剖结构不利而失败。未进行结扎，而是测试了一种新的肝动脉可调式绑扎方法。在小切口剖腹手术后，将一个扩张器假体置于肝固有动脉上。通过经植入的端口系统向假体中注入液体，可在控制下减少肝脏灌注。该方法有效减少了肝脏灌注和心脏每搏输出量，并成功治疗了心力衰竭。所述方法是在经皮栓塞失败或无法进行时，肝动脉结扎的一种替代治疗方法。
