Nisan 2018
Hepatektomi öncesi transhepatik endovasküler portal ven embolizasyonu
Transhepatic endovascular portal vein embolization before hepatectomy
- Ana Sayfa
- Sayılar
- Nisan 2018
- Hepatektomi öncesi transhepatik endovasküler portal ven embolizasyonu...
2Department of Interventional Radiology, Yeditepe University Faculty of Medicine, Istanbul
3Department of Radiology, Sancaktepe Regional Hospital, Istanbul
4Department of Internal Medicine, Lokman Hekim Hospital, Ankara5Department of Interventional Radiology,
6Department of Gastroenterology, Eskisehir Osmangazi University, Faculty of Medicine Eskisehir
Özet
Giris ve Amaç: Bu çalismanin amaci, metastatik karaciger hastaliginda genisletilmis hepatektomi öncesi transhepatik portal ven embolizasyo-nu için Embosphere, Gelfoam ve Amplatzer vascular plug II kullaniminin etkinlik ve güvenilirligini arastirmaktir. Gereç ve Yöntem: Ocak 2008 ile Ekim 2014 tarihleri arasinda, gelecekteki remnant karaciger hacmini artirmak amaciyla, genisletilmis hepatektomiden önce transhepatik en-dovasküler portal ven embolizasyonu yapilan metastatik karaciger has-taligi olan hastalar, geriye dönük degerlendirildi. Gelecekteki remnant karaciger hacmini hesaplamak için hepatektomiden önce ve sonra çok detektörlü bilgisayarli tomografi görüntüleri kullanildi. Tüm hastalarda ipsilateral portal ven embolizasyonu, mikrosiferik embolik ajan (Em-bosphere, 700-900 ?m), jelatin köpük (Gelfoam) ve Amplatzer vascular plug II kullanilarak yapildi. Primer sonuç ölçütleri, gelecekteki remnant karaciger hacminin yüzdelik artisi, prosedüre bagli mortalite ve morbi-dite, teknik ve klinik basari oranlari olarak belirlendi. Bulgular: Ortala-ma yasi 48±10.1 yil (dagilim 32-59 yil) olan toplamda 18 hastanin (12 erkek ve 6 kadin), 14’ünde (%78) sag portal ven ve 4’ünde (%22) sol portal ven transhepatik yaklasimla embolize edildi. Gelecekteki remnant karaciger hacminde 6 haftada ortalama artis orani %41.6±6.7 (dagilim %35-45) olup genisletilmis hepatektomi için yeterli idi ve klinik basari orani %100, teknik basari orani %100 idi ve prosedüre bagli mortalite yoktu. Bir hastada karacigerde kendini sinirlayan subkapsüler hematom vardi (%5). Embolize edilen portal venlerde takip süresince rekanali-zasyon olmadi. Sonuç: Metastatik karaciger hastaligi olan hastalarda genisletilmis hepatektomiden önce transhepatik portal ven embolizas-yonu için Embosphere, Gelfoam ve Amplatzer vascular plug II güvenli ve etkili prosedürdür.
Abstract
Background and Aims: To evaluate the safety and efficacy of tran-shepatic portal vein embolization with Embosphere, Gelfoam, and Am-platzer vascular plug II before extended hepatectomy in patients with metastatic liver disease. Materials and Methods: Between January 2008 and October 2014, patients with metastatic liver disease, who were treated with transhepatic endovascular portal vein embolization before extended hepatectomy to increase the future remnant liver vol-ume, were retrospectively evaluated. Multidetector computed tomog-raphy was utilized before and after the hepatectomy to calculate the future remnant liver volume. Ipsilateral portal vein embolization was performed in all patients with a microspheric embolic agent (Embo-sphere, 700–900 ?m), gelatin foam (Gelfoam), and Amplatzer vascular plug II. Primary outcome measures are the increase in the percentage of the future remnant liver volume, procedure-related mortality and morbidity, and both technical and clinical success rates. Results: Four-teen (78%) right portal vein and 4 (22%) left portal vein embolizations were performed in a total of 18 patients (12 men and 6 women) with a mean age of 48±10.1 years (range, 32 to 59 years). The mean in-crease in the future remnant liver volume at 6 weeks was 41.6±6.7% (range, 35% to 45%), which was sufficient for extended hepatectomy, and the clinical success rate was 100%. The technical success rate was 100%, and there was no procedure-related mortality. A self-limited subcapsular hematoma occurred in one patient (5%). There was no recanalization of embolized portal veins during follow-ups. Conclusion:Transhepatic portal vein embolization with Embosphere, Gelfoam, and Amplatzer vascular plug II before extended hepatectomy in patients with metastatic liver disease, is a safe and effective procedure.
