OBJECTIVE: To study the effect of preoperative selective portal vein embolization (SPVE) in thetwo-step hepatectomy for patients with primary hepatocellular carcinoma (HCC) in injured livers.METHODS: Twenty-six patients with HCC and cirrhosis who were not suitable for curative hepatectomywere treated by ultrasound-guided percutaneous transhepatic SPVE with a fine needle. The success rate,side-effects and complications of SPVE, serial changes of hepatic lobe volume and rate of two-step curativehepatectomy after SPVE were observed.RESULTS: SPVE was performed in 24 patients (92.3%). In patients whose right portal vein brancheswere embolized, the right hepatic volume decreased but the left hepatic volume increased gradually. Theratio of the right hepatic volume to the total hepatic volume decreased from 64.O% before SPVE to 60.8%after 1 week, 55.1% after 2 weeks and 52.7% after 3 weeks, respectively. The side-effects includeddifferent degree of pain in the liver quandrant (17 patients), lower fever (9), and nausea and vomiting(7). The levels of aspartate alanine transaminase (AST), alanine transaminase (ALT) and total bilirubin(TBIL) increased after SPVE, but returned to the preoperative levels in 1 week. After 2-4 weeks,two-step curative hepatectomy for HCC was performed in 13 patients (54.2%).CONCLUSIONS: Ultrasound-guided percutaneous transhepatic SPVE with a fine needle is feasible andsafe. It can extend the indications of curative hepatectomy for HCC in injured livers, and increase thesafety of two-step hepatectomy. OBJECTIVE: To study the effect of preoperative selective portal vein embolization (SPVE) in thetwo-step hepatectomy for patients with primary hepatocellular carcinoma (HCC) in injured livers. METHODS: Twenty-six patients with HCC and cirrhosis who were not suitable for curative hepatectomywere treated by ultrasound-guided percutaneous transhepatic SPVE with a fine needle. The success rate, side-effects and complications of SPVE, serial changes of hepatic lobe volume and rate of two-step curativehepatectomy after SPVE were observed .RESULTS: SPVE was performed in 24 Patients with right portal vein branches were embolized, the right hepatic volume decreased but the left hepatic volume increased gradually. Theratio of the right hepatic volume to the total hepatic volume decreased from 64.O% before SPVE to 60.8% after 1 week, 55.1% after 2 weeks and 52.7% after 3 weeks, respectively. The side-effects included different degrees of pain in the liver quandrant (17 patients), lo wer fever (9), and nausea and vomiting (7). The levels of aspartate alanine transaminase (AST), alanine transaminase (ALT) and total bilirubin (TBIL) increased after SPVE, but returned to the preoperative levels in 1 week. After It can extend the indications of curative hepatectomy for HCC was injured in 13 patients (54.2%). CONCLUSIONS: Ultrasound-guided percutaneous transhepatic SPVE with a fine needle is feasible and safe. It can extend the indications of curative hepatectomy for HCC in injured livers, and increase the safety of two-step hepatectomy.