摘要
目的探讨对肝门部胆管癌行扩大右半肝切除术前使用经皮经肝门静脉栓塞术(portalveinembolization,PVE)的疗效。方法2005年10月对1例伴有肝硬化的肝门部胆管癌施行经皮经肝门静脉栓塞术(percutaneousportalveinembolization,PTPE),记录肝脏在血流动力学、体积、功能、病理方面的改变。结果PTPE术后第5天体温升至39.2℃,然后逐渐下降,同时伴有轻度右上腹痛,无恶心呕吐,未见腹腔出血及胆漏。PTPE术后左叶体积从417.0ml增加到522.4ml(肥大率125.2%);右叶体积从1041·3ml减少到1017·4ml(萎缩率97.7%);左叶占全肝的体积比从28.6%升至33·9%。左矢状部血流速度术前为12·8ml/s,术后当日、第6天分别为23·2、17·1ml/s。较原流量增加100%和39%(术后当日,第6天)。PTPE术后17d左肝胆汁的引流量超过右肝。PTPE术后34d患者接受扩大右半肝切除术,术中见肝左叶可见明显的肥大,肝脏5、6、7段(S5,6,7)与其余肝段间有明显的界限,术后3个月病情平稳。术后病理:栓塞叶门静脉狭窄及闭塞而肝细胞变性,坏死及凋亡。结论PVE能有效诱导未栓塞肝叶的肥大,从而提高对伴有肝损害的患者行扩大肝脏切除的安全性。
Objective To assess the clinical efficacy of percutaneous transhepatic portal embolization （PTPE） before the extended right hemihepatectomy for the treatment of hilar cholangiocarcinoma. Methods We successfully carried out a percutaneous transhepatic portal embolization in a patient with hilar cholangiocarcinoma and liver cirrhosis. Hepatic hemodynamics, liver volume, liver functions, and pathological changes were recorded after the procedure. Results After PTPE, the patient developed an inflammatory l：esponse manifested by a transient fever （39.2 ℃ at peak on the 5th postoperative day） and a mild abdominal pain. There were no other complications such as nausea, vomitting, hemorrhage, or bile leakage. The volume of the left lobe increased from 417.0 ml to 522. 4 ml （enlargement rate, 125. 2% ）; the volume of the right lobe decreased from 1041. 3 ml to 1017. 4 ml （ diminishment rate, 97.7% ）. The ratio of the left lobe to the whole liver increased from 28.6% to 33.9%. The velocity of blood flow of the left portal vein increased by 100% and 39% on the day of operation and the 6th day after operation, respectively （ from 12.8 ml/s preoperatively to 23.2 ml/s and 17.1 ml/s）. The values of ICG R15 and ICG-K returned to normal levels. On the 17th day after PTPE, the quantity of bile drainage from the left lobe exceeded that from the right lobe. The extended right hemihepatectomy was performed 34 days after PTPE. During operation, an obvious hypertrophy of the left lobe and a distinct demarcation line between the segment 5, 6, and 7 （S5,6,7） and other segments were observed. Postoperative recovery was uneventful. The pathological examination found stenosis and embolization of the portal vein, as well as the degeneration, necrosis, and apotosis of the liver cells in the embolized lobe. Conclusions Portal vein embolization can effectively induce the hypertrophy of the unembolized lobe, which increases the safety level of following extended hemihepatectomy in patients with impared liver functions.
出处
《中国微创外科杂志》
CSCD
2007年第1期50-53,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
胆管癌
肝门部胆管
门静脉栓塞
肝脏切除术
Cholangiocarcinoma
hilar bile duct
Portal vein embolization
Hepatectomy
