Hepatektomi Öncesi Transhepatik Endovasküler Portal Ven Embolizasyonu

Yıl 2018, Cilt: 17 Sayı: 1, 33 - 37, 24.04.2018

Çetin Murat Altay Osman Melih Topçuoğlu Ayhan Alpar Murat Bülent Küçükay Fahrettin Küçükay Tuncer Temel

https://doi.org/10.17941/agd.405337

Öz

Giriş ve Amaç: Bu çalışmanın amacı, metastatik karaciğer hastalığında genişletilmiş hepatektomi öncesi transhepatik portal ven embolizasyonu için Embosphere, Gelfoam ve Amplatzer vascular plug II kullanımının etkinlik ve güvenilirliğini araştırmaktır. Gereç ve Yöntem: Ocak 2008 ile Ekim 2014 tarihleri arasında, gelecekteki remnant karaciğer hacmini artırmak amacıyla, genişletilmiş hepatektomiden önce transhepatik endovasküler portal ven embolizasyonu yapılan metastatik karaciğer hastalığı olan hastalar, geriye dönük değerlendirildi. Gelecekteki remnant karaciğer hacmini hesaplamak için hepatektomiden önce ve sonra çok detektörlü bilgisayarlı tomografi görüntüleri kullanıldı. Tüm hastalarda ipsilateral portal ven embolizasyonu, mikrosiferik embolik ajan (Embosphere, 700-900 μm), jelatin köpük (Gelfoam) ve Amplatzer vascular plug II kullanılarak yapıldı. Primer sonuç ölçütleri, gelecekteki remnant karaciğer hacminin yüzdelik artışı, prosedüre bağlı mortalite ve morbidite, teknik ve klinik başarı oranları olarak belirlendi. Bulgular: Ortalama yaşı 48±10.1 yıl (dağılım 32-59 yıl) olan toplamda 18 hastanın (12 erkek ve 6 kadın), 14’ünde (%78) sağ portal ven ve 4’ünde (%22) sol portal ven transhepatik yaklaşımla embolize edildi. Gelecekteki remnant karaciğer hacminde 6 haftada ortalama artış oranı %41.6±6.7 (dağılım %35-45) olup genişletilmiş hepatektomi için yeterli idi ve klinik başarı oranı %100, teknik başarı oranı %100 idi ve prosedüre bağlı mortalite yoktu. Bir hastada karaciğerde kendini sınırlayan subkapsüler hematom vardı (%5). Embolize edilen portal venlerde takip süresince rekanalizasyon olmadı. Sonuç: Metastatik karaciğer hastalığı olan hastalarda genişletilmiş hepatektomiden önce transhepatik portal ven embolizasyonu için Embosphere, Gelfoam ve Amplatzer vascular plug II güvenli ve etkili prosedürdür.

Anahtar Kelimeler

Karaciğer, portal ven, embolizasyon, Embosfer, Gelfoam, AVP, hepatektomi

Transhepatic Endovascular Portal Vein Embolization Before Hepatectomy

Öz

Background and Aims: To evaluate the safety and efficacy of transhepatic portal vein embolization with Embosphere, Gelfoam, and Amplatzer 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 volume, were retrospectively evaluated. Multidetector computed tomography 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 (Embosphere, 700–900 µm), 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: Fourteen (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 increase 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.

Anahtar Kelimeler

Liver, portal vein, embolization, Embosphere, Gelfoam, Amplatzer vascular plug, hepatectomy

Kaynakça

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