摘要
目的探讨选择性门静脉栓塞技术细节及其在残余肝容积不足患者肝切除术前应用的临床意义。方法2008年1月至2012年7月，6例肝脏肿瘤因残余肝容积不足，二期肝切除术前行选择性门静脉栓塞术。结果6例选择性门静脉栓塞术均成功。无手术并发症，栓塞对肝功能影响轻微。术前，6例残余肝容积平均（474．33±89．19）cm^3，术后6周，平均（722．67±151．51）cm^3，术前术后残余肝容积比较差异有统计学意义（t=-5．587，P=0．003）。术前6例肝脏肿瘤负荷（瘤体总体积）平均（134±181）cm^3，栓塞术后6周，肿瘤负荷平均为（270±346）cm^3，栓塞前后肿瘤负荷比较差异无统计学意义（t=-1．64，P=0．16）。5例二期肝切除术顺利。1例未行肝切除术。随访中位时间为37个月，4例存活（2例无瘤生存），1例死亡。结论门静脉选择性栓塞是肝切除前增加残余肝容积的有效技术手段；经同侧（患侧）入路并选择弹簧圈作为栓塞材料简单易行、安全、有效。门静脉栓塞前，应以化疗或选择性肝动脉化疗栓塞等手段有效控制肿瘤生长。
Objective To evaluate the technique of selective portal vein embolization before hepatectomy and its value in the preparation of major hepatic resection for those with insufficient future remnant liver. Methods From Jan 2008 to July 2012, 6 patients who suffered from hepatic tumors underwent selective ipsilateral portal vein embolization （PVE） due to insufficient future remnant liver volume （FRLV） before second-stage major hepatic resection. Results Technically, all six PVE were completed successfully with only minor liver function damages. The average FRLV increased from （474. 33 ± 89. 19） cm^3 to （722. 67 ± 151.51 ） cm^3 （ t = - 5. 587, P = 0. 003 ）. The average tumor burden （ total tumor volume） increased from （ 134 ± 181 ） cm^3 to （270 ± 346） cm^3 （ t = - 1.64, P = 0. 16）. Five cases underwent second- stage major hepatectomy 6 weeks after PVE, while in 1 case a resection attempt was abandoned because of uncontrolled tumor growth during the period. During the follow-up period （ median 37 months） , 1 died, 4 survived, 2 were tumor-free. Conclusions Selective portal vein embolization is a safe and effective method to induce hepatic hypertrophy in the appropriate clinical setting. Before PVE, hepatic tumor should be controlled beforehand with chemotherapy or TACE to ensure the scheduled second-stage hepatectomy.
出处
《中华普通外科杂志》
CSCD
北大核心
2013年第7期515-518,共4页
Chinese Journal of General Surgery
关键词
肝肿瘤
门静脉
栓塞
治疗性
Liver neoplasms
Portal vein
Embolization, therapeutic
