摘要
目的评价肝门部胆管癌扩大肝切除术前行门静脉栓塞术的有效性及安全性,比较门静脉栓塞手术切除术与非门静脉栓塞手术切除术后结果。方法 2007年5月至2010年10月收治肝门部胆管癌患者57例,分为两组,将预保留肝占全肝体积<50%、术前接受门静脉栓塞(PVE)者设为PVE组(26例),男16例,女10例,年龄(56.48±7.62)(39～73)岁,最终接受扩大肝切除者为PVE手术组(24例),同期未行PVE而接受扩大肝切除术者为非PVE手术组(31例),男性16例,女性15例,年龄54.68±10.46(33～72)岁,预保留肝叶(FLR)占全肝体积比>50%。记录PVE前后肝脏体积、功能等方面的变化,比较PVE手术组与非PVE手术组术后住院天数、术后肝功、术后死亡率、并发症发生率及术后生存率。结果 26例患者均成功实施PVE术,24例接受根治性手术治疗,1例PVE术后未栓塞侧有肿瘤转移,肝门部及腹膜后淋巴结多处转移而取消手术治疗,1例PVE后因合并乙肝后肝硬化预保留肝叶增生不全,未能接受手术。PVE手术组与非PVE手术组的性别、年龄、术前引流情况、Bismuth分型、术中出血、手术前后肝功等方面差别均无统计学意义,两者术后并发症发生率和死亡率的差别无统计学意义,两组术后中位生存时间分别为25.99月、26.14月,PVE手术组与非PVE手术组术后1,2年生存率分别82%、53%和87%、51%。两组总生存率比较无统计学意义(P=0.89)。结论肝门部胆管癌扩大肝切除术前行PVE术可以扩大肝门部胆管癌的手术指征、增加手术的安全性、改善患者的长期预后,使其围手术期并发症、远期生存率达到或接近于可以直接手术切除的肿瘤患者。
Objective To evaluate the therapeutic efficacy and safty of preoperative portal vein embolization and compare outcomes with and without portal vein embolization before hepatectomy for hilar cholangiocarcinoma.Methods From May 2007 to October 2010,57 patients with hilar cholangiocarcinoma were treated.26 of these patients were not candidate for surgery because the remnent liver was deemed to be too small.PVE was performed to these 26 patients,comprised 16 men and 10 women,with an average age of（56.48±7.62）（39~73）y.Other 31 patients with sufficient remnent liver volume underwent major liver resection without previous PVE,comprised 16 man and 15 women,with an average age of（54.68±10.46）（33~72）y.Liver volume and liver functions were recorded after the procedure.The operative outcomes were compared between patients with or without PVE.Result Successful PVEs achieved in all cases,24 of these patients underwent major hepatectomy.Tumor metastasis kept one patient from hepatectomy.Deficiency of FLR regeneration appeared in another patient,which prevented him from receiving operation.There were statistical differences in future liver remnent and the ratio of FLR /TELV between after PVE and before PVE.There was no significant difference in terms of the rate of morbidity and in-hospital mortality between the PVE group and non-PVE group.The median survival time of the PVE group and the non-PVE group were 25.99 months、26.14 months,respectively.The 1-and 2-year overall survivals of the PVE group and the non-PVE group were 82% and 53%;87% and 51%,respectively.No statistically significant differences were observed in overall survival（P=0.89）.Conclusions Preoperative PVE can be considered safe and effective for patients with small future liver remnants.It can lessen postoperative liver failure and widen the indication of the surgical resection,especially in patients with marginal future liver remnants.
出处
《肝胆外科杂志》
2011年第6期415-419,共5页
Journal of Hepatobiliary Surgery
关键词
肝门部胆管癌
门静脉栓塞
肝切除术
hilar cholangiocarcinoma
portal vein embolization
radical resection
