광범위 간절제술에서 수술전 간문맥 색전술의 역할 = The Role of the Preoperative Portal Vein Embolization in Major Hepatectomy

다국어 초록 (Multilingual Abstract)

Purpose : To assess the role of the preoperative portal vein embolization (PVE) in patients in need of majorhepatectomy. Materials and Methods : Total of 11 cases consisted of Klatskin tumor (n=6), gallbladder cancer(n=2), and hepatocellular carcinoma (n=3). After percutaneous transhepatic puncture of portal vein (right : 7,left : 4), the embolization of 1st order branch of right portal vein was done with Gentamicin soaked Gelfoamcubes. Radiologically, the angle between the middle hepatic vein and the inferior vena cava was measured on pre-and post-PVE CT (F/U: 10 days) to evaluate the hypertrophy of the left lobe. Clinically, amount and nature of thedrained bile drained through the PTBD tube of both lobes were analyzed in 5 patients with Klatskin tumor. Theinterval between PVE & operation was 10-24 days. Operative findings & the changes of postop. total bilirubin wereanalyzed and the complication after procedure was checked. Results : There was decrease in mean angle between themiddle hepatic vein and the inferior vena cava from 35.9 degree to 23.9 degree, but it was insignificantstatistically (p=0.09). The embolization of right portal vein was done and there was increase in amount of drainedbile from the nonembolized left lobe by 2-3 folds 8-14 day after PVE. The color and consistency between both lobeswere significantly different; right lobe was darker in color and softer in consistency. Postoperative totalbilirubin increased by 2-3 folds 1 to 4 days after PVE and normalized 10 to 14 days after PVE. Most of thepatients had mild abdominal pain and fever after PVE and 1 patient had localized hematoma at puncture site whichwas subsided spontaneously. Conclusion : The preoperative portal vein embolization is a useful method forminimizing postoperative liver failure in patients in need of major hepatectomy.