超选择性肝动脉栓塞对症状性多囊肝患者囊肿体积和肝功能的影响

The study on super selective hepatic artery embolization for effects of hepatic cyst volume and liver function of symptomatic patients with polycystic liver

目的：探究超选择性肝动脉栓塞（TAE）对症状性多囊肝（PLD）患者囊肿体积和肝功能的影响,为临床诊疗提供可靠依据。方法：选取14例采用超选择性TAE治疗的PLD患者,通过TAE治疗前及术后1年对上腹进行CT扫描,且测定患者肝部囊肿的体积大小情况。观察患者经TAE治疗前肝部囊肿总体积的变化情况以及术后肝肾功能的变化和不良反应,且于术后4个月随访患者的症状改善状况。结果：14例患者通过造影技术显示肝脏体积存在不同程度增大,造影显示囊壁供血主要为肝动脉分支,肝区有大小不同的圆形未染色区,CT检查与未染色区显示多囊肝肿区一致。14例PLD患者经TAE治疗前与治疗后12个月肝部囊肿总体积比较有差异（t=2.8627,P〈0.05）;14例PLD患者经TAE治疗前及术后1周实验室检查血清谷草转氨酶（AST）、谷丙转氨酶（ALT）、白蛋白（ALB）及总胆红素（TBIL）的比较无差异（t=0.0441,t=0.3316,t=0.0722,t=1.9855;P〉0.05）。与术前对比,TAE对患者肝功能的影响较小,患者在术后3～12个月症状逐步改善及体力评分逐渐提高,术后12个月改善率为100%,体力评分为90～100分。14例患者在术后1～5 d的栓塞综合症逐步消失,术后5 d症状消失。结论：TAE治疗对PLD患者有明显的效果,其复发率低,可提高疗效、减轻患者痛苦,值得在临床上推广应用。

Objective： To investigate the super selective transhepatic arterial embolization（TAE） for effects of cyst volume and liver function in patients with symptomatic polycystic liver disease（PLD）, and provide a reliable basis for clinical diagnosis and treatment. Methods： 14 cases of symptomatic patients with PLD were selected from October 2014 to October 2015 in our hospital using super selective hepatic arterial embolization. The upper abdomen was performed CT scan one year after surgery, and the volume of patients with liver cyst was tested. We observed the changes of total volume of liver before TAE and postoperative kidney function, adverse reactions, and the improvements after four months＇ follow-up. Results： The angiography for the 14 patients showed liver volume increased in different degrees. It also showed that blood supply was mainly hepatic artery wall branch. There were different sizes of liver round unstained area. There was consistent between CT examination and unstained area in polycystic liver swollen area. The difference of the total volume of the liver cyst was statistically significant in 14 cases of the patients with PLD before TAE treatment and after 12 months＇ treatment（t=2.8627, P〈0.05）. 14 cases of the patients with PLD after TAE before treatment and after 1 week＇s laboratory tests, the difference was not statistically significant among AST, ALT, ALB and TBIL（t=0.0441, t=0.3316, t=0.0722, t=1.9855; P〉0.05）. Compared with the preoperative, there was little effect on liver function by TAE. After 3 to 12 months, symptoms gradually improved and physical rating increased. The improvement rate was 100% after 12 months and the physical score was from 90 to 100 points. The embolism syndrome in 14 cases of patients gradually disappeared after 1 to 5 days, and five days later the symptoms disappeared. Conclusions： There is a significant effect for symptomatic polycystic liver patients with TAE. It can improve efficacy and reduce patient suffering with a low recurrence rate. It is worthy of clinical application.