经皮经肝选择性门静脉栓塞技术及其安全性评价

目的 探讨经皮经肝选择性门静脉栓塞术(SPVE)的技术要点和安全性.方法 对41例肝脏肿瘤患者(包括原发性肝癌13例,转移性肝癌28例)行SPVE,对其中32例同期行TACE术(SPVE+ TACE组),9例未行或未同期行TACE术(单纯SPVE组).术后回顾性分析SPVE的技术要点、并发症及临床安全性.结果 对41例均成功完成SPVE术,成功率100％；术后第3天患者ALT、AST、TB较术前升高,SPVE+TACE组升高更为明显,至术后第7天均明显下降.5例出现SPVE相关并发症,包括2例异位门静脉栓塞、1例暂时性肝功能衰竭、1例肝包膜下出血和1例肝内门静脉-静脉瘘.结论 SPVE作为肝脏外科手术和TACE术的重要辅助技术是可行的,但术后相关并发症应引起足够重视.

Percutaneous transhepatic selective portal vein embolization: Technique and security

Objective To discuss the main technical methods of percutaneous transhepatic selective portal vein embolization (SPVE), and to assess its security. Methods Forty-one patients (13 with primary liver carcinoma and 28 with metastatic liver cancer) underwent SPVE, 32 of which simultaneously underwent TACE (SPVE+TACE group), while 9 of which did not undergo TACE within 1 week of SPVE (single SPVE group). The technology of SPVE, procedure-related complications and its clinical security were retrospectively analyzed. Results SPVE was successfully performed in all 41 patients, and the success rate was 100%. On the 3rd day after treatment, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TB) increased, in SPVE+TACE group more obviously than in single SPVE group. However, on the 7th day after treatment, ALT, AST and TB decreased significantly. Complications caused by SPVE occurred in 5 patients, including ectopic portal embolization in 2 patients, transient liver failure, liver capsule bleeding, and portal vein-hepatic vein fistula in 1 patient, respectively. Conclusion SPVE is an important aided technology for liver surgery and TACE. However, sufficient attention should be paid to the relevant complications caused by the operation.