超选择性肝动脉栓塞治疗症状性多囊肝临床效果

The clinical efficacy of transcatheter super-selective hepatic artery embolization for the treatment of symptomatic polycystic liver disease

目的探讨超选择性肝动脉栓塞（TAE）治疗症状性多囊肝（PLD）的临床效果。方法回顾性分析2009年至2013年采用超选择性TAE治疗症状性PLD患者8例,其中女6例,男2例,年龄54~65岁,平均59.5岁。栓塞剂为聚乙烯醇（PVA）颗粒和微弹簧圈。所有患者在TAE术前及术后12个月均接受上腹部CT平扫加增强扫描及肝内囊肿总体积测量,比较囊肿体积变化。统计学分析采用配对t检验。结果 TAE技术成功率为100%。术后患者出现不同程度肝区不适、发热,给予积极对症支持治疗后症状均消失,无一例出现严重并发症。术后随访12个月,肝内囊肿总体积由术前平均（5 794±2 066）cm3（3 120~8 935 cm3）改善为术后12个月平均（3 832±1 525）cm3（2 019~5 925 cm3）,差异有统计学意义（配对t=6.971,P〈0.001）。肝内囊肿总体积缩小率为（34.6±11.3）%（24.3%~60.4%）。结论 TAE是一种治疗症状性PLD的新方法 ,具有安全有效、疗效可靠、并发症少等优点,有较高的临床推广应用价值。

Objective To evaluate the clinical efficacy of transcatheter super-selective hepatic artery embolization （TAE） in treating symptomatic polycystic liver disease （PLD）. Methods A total of 8 patients with PLD, who were admitted to authors’ hospital during the period from 2009 to 2013 to receive TAE, were enrolled in this study. The patients included 6 females and 2 males with a mean age of 59.5 years （54-65 years）. The used embolic agents were polyvinyl alcohol （PVA） microspheres and micro spring coils. Both plain and contrast-enhanced CT scans of the upper abdomen were performed before TAE as well as at 12 months after TAE; the total volume of the hepatic cysts was measured and the changes of the cystic volume were determined. Statistical analysis was conducted using paired t test. Results The technical success rate was 100%. After TAE, the patients developed fever and different degrees of discomfort at liver area, which were disappeared after active symptomatic medication, and no serious complications occurred. The patients were followed up for 12 months , the mean total volume of the intrahepatic cysts decreased from preoperative （5 794±2 066） cm3 （range 3 120-8 935 cm3） to postoperative （3 832±1 525） cm3 （range 2 019-5 925 cm3）, the difference was statistically significant （t=6.971, P〈0.001）. The reduction ratio of total volume of intrahepatic cysts was 34.6%±11.3%（24.3%-60.4%）. Conclusion For symptomatic polycystic liver disease, transcatheter super-selective hepatic arterial embolization is a newly-developed treatment. This technique is safe and effective with reliable response and fewer complications. Therefore, it should be recommended in clinical practice.