臨床外科62巻6号

2007年06月発行

特集 肝胆膵術後合併症―その予防のために

門脈枝塞栓術

著者： 石崎陽一¹ 川崎誠治¹

所属機関： ¹順天堂大学医学部肝胆膵外科

ページ範囲：P.769 - P.774

要旨：近年，肝切除の安全性が確立され，大腸癌多発性肝転移，肝門部胆管癌，肝細胞癌などに対して積極的に拡大肝切除をする傾向にある．しかしながら，根治性のために大量肝切除が必要となる症例では術後の肝不全が危惧される．肝が正常と考えられる症例で，術前の残肝容積が全肝容積の40％以下と予想される場合には術前門脈枝塞栓術を施行する．これにより塞栓葉は萎縮し，非塞栓葉である予定残肝の代償性肥大が期待され，拡大手術後の肝不全のリスクを軽減することができる．門脈枝塞栓術は手技に伴う合併症も少なく，門脈枝塞栓術後に切除可能となった症例の生存率は門脈枝塞栓術非施行の切除例の生存率と変わらず，今日では大量肝切除が必要と考えられる症例では必須の手技となった．

参考文献

1）Makuuchi M, Thai B-L, Takayasu K, et al：Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma：a preliminary report. Surgery 107：521-527, 1990

2）Seyama Y, Kubota K, Sano K, et al：Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 238：73-83, 2003

3）石崎陽一，川崎誠治：大腸癌両葉多発性肝転移に対する外科治療．門脈塞栓術を併用した肝切除術．日外会誌 107：116-121，2006

4）Wakabayashi H, Ishimaru K, Okano K, et al：Application of preoperative portal vein embolization before major hepatic resection in patients with normal or abnormal liver parenchyma. Surgery 131：26-33, 2002

5）Hemming AW, Reed AI, Howard RJ, et al：Preoperative portal vein embolization for extended hepatectomy. Ann Surg 237：686-693, 2003

6）Farges O, Belghiti J, Kianmanesh R, et al：Portal vein embolization before right hepatectomy. Prospective clinical trial. Ann Surg 237：208-217, 2003

7）Vauthey J-N, Chaoui A, Do K-A, et al：Standardized measurement of the future liver remnant prior to extended liver resection：Methodology and clinical associations. Surgery 127：512-519, 2000

8）Nagino M, Kamiya J, Kanai M, et al：Right trisegment portal vein embolization for biliary tract carcinoma：technique and clinical utility. Surgery 127：155-160, 2000

9）Abdalla EK, Hicks ME, Vauthey JN：Portal vein embolization：rationale, technique and future prospects. Br J Surg 88：165-175, 2001

10）Di Stefano DR, de Baere T, Denys A, et al：Preoperative percutaneous portal vein embolization：evaluation of adverse events in 188 patients. Radiology 234：625-630, 2005

11）Gruttadauria S, Luca A, Mandala' L, et al：Sequential preoperative ipsilateral portal and arterial embolization in patients with colorectal liver metastasis. World J Surg 30：576-578, 2006

12）Kawasaki S, Makuuchi M, Kakazu T, et al：Resection for multiple metastatic liver tumors after portal embolization. Surgery 115：674-677, 1994

13）Azoulay D, Casting D, Smail A, et al：Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 231：480-486, 2000

14）Elias D, Ouellet JF, Baère T, et al：Preoperative selective portal vein embolization before hepatectomy for liver metastases：long-term results and impact on survival. Surgery 131：294-299, 2002

15）Jaeck D, Oussoultzoglou E, Rosso D, et al：A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 240：1037-1051, 2004

16）Oussoultzoglou E, Bachellier P, Rosso E, et al：Right portal vein embolization before right hepatectomy for unilobar colorectal liver metastases reduces the intrahepatic recurrence rate. Ann Surg 244：71-79, 2006

17）Kawasaki S, Imamura H, Kobayashi A, et al：Results of surgical resection for patients with hilar bile duct cancer. Ann Surg 238：84-92, 2003

18）Nagino M, Kamiya J, Nishio H, et al：Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliray cancer. Ann Surg 243：364-372, 2006

19）Aoki T, Imamura H, Hasegawa K, et al：Sequential preoperative arterial and portal venous embolizations in patients with hepatocellular carcinoma. Arch Surg 139：766-774, 2004