Portal Vein Embolization and Autologous CD133+ Bone Marrow Stem Cells for Liver Regeneration: Initial Experience1
门静脉栓塞术和自身CD133+骨髓干细胞加速肝组织再生：初步经验
Günter Fürst, MD, Jan Schulte am Esch, MD, Ludger W. Poll, MD, Stefan B. Hosch, MD, L. Benjamin Fritz, MD, Michael Klein, MD, Erhard Godehardt, MD, Andreas Krieg, MD, Britta Wecker, Volker Stoldt, MD, Marcus Stockschläder, MD, Claus F. Eisenberger, MD, Ulrich Mödder, MD and Wolfram T. Knoefel, MD
1 From the Institute of Diagnostic Radiology (G.F., L.W.P., L.B.F., B.W., U.M.) and Departments of General Surgery (J.S.a.E., S.B.H., A.K., C.F.E., W.T.K.), Cardiothoracic Surgery (M.K., E.G.), and Hemostaseology and Transfusion Medicine (V.S., M.S.), Heinrich-Heine-University of Duesseldorf, Moorenstr 5, 40225 Duesseldorf, Germany. Received April 7, 2006; revision requested June 5; final revision received June 19; accepted August 24. Address correspondence to L.B.F. (e-mail: ben@fritz.md).
Purpose: To prospectively evaluate the effectiveness of portal vein embolization (PVE) and CD133+ bone marrow stem cell (BMSC) administration to the liver, compared with PVE alone, to augment hepatic regeneration in patients with large hepatic malignancies.
目的：预评估肝脏门静脉栓塞术(PVE)和给予自身CD133+骨髓干细胞(BMSC) 与单纯PVE比较对于巨大肝脏恶性肿瘤患者肝脏再生的调节作用。
Materials and Methods: The study was approved by the institutional ethics committee; informed consent was obtained. Thirteen patients underwent PVE of liver segments I and IV-VIII to stimulate hepatic regeneration prior to extended right hepatectomy. In six patients (three men, three women; mean age, 61 years; range, 46–72 years) with a future liver remnant volume (FLRV) below 25% and/or limited quality of hepatic parenchyma, PVE alone did not promise adequate proliferation. These patients underwent BMSC administration to segments II and III (group I). In seven patients (three men, four women; mean age, 69 years; range, 63–75 years) with an FLRV below 25%, PVE alone was performed (group II). Two radiologists blinded to patients' identity and each other's results measured liver and tumor volumes with helical computed tomography. Absolute, relative, and daily FLRV gains were compared by using the t test or the Wilcoxon test.
材料和方法：伦理委员会支持这项研究，获得试服志愿书。13例患者在行扩大右半肝切除术前行肝I 和 IV-VIII段门静脉栓塞术来刺激肝脏再生。6例准备肝脏残余(FLRV)小于25%和/或肝实质品质受限的患者（男性 3例，女性 3例，平均年龄 61岁，范围 46–72 years)，单独行PVE不能完成需要的肝脏再生，这些患者注射BMSC到肝段II 和 III (组 I)。7例准备肝脏残余(FLRV)小于25%的患者（男性 3例，女性 4例，平均年龄 69岁，范围 63–75 years)，单独行PVE (组II)。两名放射科医生分别在不知患者情况和不知彼此结果的情况下应用螺旋CT测量肝脏和肝肿瘤体积。使用t test 或 Wilcoxon test比较绝对、相对和每日的FLRV增加量。
Results: The increase of the mean absolute FLRV in group I from 239.3 mL ± 103.5 (standard deviation) to 417.1 mL ± 150.4 was significantly higher than that from 286.3 mL ± 77.1 to 395.9 mL ± 94.1 in group II (P = .049). The relative gain of FLRV after PVE in group I (77.3% ± 38.2) was significantly higher than that in group II (39.1% ± 20.4) (P = .039). The daily hepatic growth rate in group I (9.5 mL/d ± 4.3) was significantly superior to that in group II (4.1 mL/d ± 1.9) (P = .03). Time to surgery was 27 days ± 11 in group I and 45 days ± 21 in group II (P = .057).
结果：组 I 平均绝对FLRV 增长量从239.3 mL ± 103.5 (标准偏差) 到417.1 mL ± 150.4显著高于组II的286.3 mL ± 77.1 到 395.9 mL ± 94.1 (P = .049)。组 I在PVE之后相对FLRV 增长量(77.3% ± 38.2) 显著高于组II的(39.1% ± 20.4) (P = .039)。组 I的每日肝增长率(9.5 mL/d ± 4.3) 显著高于组II的(4.1 mL/d ± 1.9) (P = .03)。等待手术时间组 I为27天 ± 11，组II为45 天 ± 21 (P = .057)。
Conclusion: In patients with malignant liver lesions, the combination of PVE with CD133+ BMSC administration substantially increased hepatic regeneration compared with PVE alone.
结论：在恶性肝脏疾病的患者中，联合行PVE 和 CD133+ BMSC注射比单独行PVE能够更实质的增加肝脏再生。
门静脉栓塞术和自身CD133+骨髓干细胞加速肝组织再生：初步经验
目的：预评估肝脏门静脉栓塞术(PVE)和给予自身CD133+骨髓干细胞(BMSC) 与单纯PVE比较对于巨大肝脏恶性肿瘤患者肝脏再生的调节作用。
材料和方法：伦理委员会支持这项研究，获得试服志愿书。13例患者在行扩大右半肝切除术前行肝I 和 IV-VIII段门静脉栓塞术来刺激肝脏再生。6例准备肝脏残余(FLRV)小于25%和/或肝实质品质受限的患者（男性 3例，女性 3例，平均年龄 61岁，范围 46–72 years)，单独行PVE不能完成需要的肝脏再生，这些患者注射BMSC到肝段II 和 III (组 I)。7例准备肝脏残余(FLRV)小于25%的患者（男性 3例，女性 4例，平均年龄 69岁，范围 63–75 years)，单独行PVE (组II)。两名放射科医生分别在不知患者情况和不知彼此结果的情况下应用螺旋CT测量肝脏和肝肿瘤体积。使用t test 或 Wilcoxon test比较绝对、相对和每日的FLRV增加量。
结果：组 I 平均绝对FLRV 增长量从239.3 mL ± 103.5 (标准偏差) 到417.1 mL ± 150.4显著高于组II的286.3 mL ± 77.1 到 395.9 mL ± 94.1 (P = .049)。组 I在PVE之后相对FLRV 增长量(77.3% ± 38.2) 显著高于组II的(39.1% ± 20.4) (P = .039)。组 I的每日肝增长率(9.5 mL/d ± 4.3) 显著高于组II的(4.1 mL/d ± 1.9) (P = .03)。等待手术时间组 I为27天 ± 11，组II为45 天 ± 21 (P = .057)。
结论：在恶性肝脏疾病的患者中，联合行PVE 和 CD133+ BMSC注射比单独行PVE能够更实质的增加肝脏再生。
