门静脉栓塞化疗术在肝癌肝三叶切除术中的初步应用  

Application of portal vein chemoembolization in major hepatectomy for initially unresectable primary and secondary hepatic tumors

作　　者：姜振中[1] 戴勇[1] 姜旭生[1] 朱民[1] 张秀国[1] 见文成[2] 

机构地区：[1]山东大学齐鲁医院普外科,济南250012 [2]山东大学齐鲁医院放射科,济南250012

出　　处：《中华医学杂志》2011年第8期532-534,共3页National Medical Journal of China

摘　　要：目的探讨无法常规根治性切除的原发性及转移性肝癌的外科治疗方法并观察其疗效。方法对1例乙状结肠癌并同时左、右肝多发转移患者一期行根治性原发肿瘤切除及肝左外叶切除，术后行右肝门静脉栓塞化疗（PVCE），5周后行右半肝切除术。对另1例巨大原发性肝癌患者，先行肝动脉栓塞化疗，1周后行PVCE，PVCE后4周行肝右三叶切除术。结果PVCE术前患者肝脏体积分别是左肝435．1cm^3，右肝1380．0cm^3肝左外叶151．5cm^3，右三叶1685．4cm^3；PVCE术后4周，右肝显著缩小，左肝代偿性增大。患者肝脏体积分别是左肝624．4cm^3，右肝740．2cm^3。左外叶560．2cm^3，右三叶1228．1cm^3剩余肝脏的体积占估计全肝体积的比率从PVCE术前的25．6％、13．6％分别升至PVCE4周的50．0％、43．1％。肝切除术后肝功能恢复良好，血清癌胚抗原及甲胎蛋白水平恢复正常。2例患者术后分别随访18、8个月，无复发。结论PVCE可防止肝大部切除术后的肝功能衰竭，扩大肝切除术的适应证。Objective To investigate the surgical treatment of initially unresectable primary and secondary hepatic tumors. Methods For the patients with multiple and bilobar colonic hepatic metastases, a first-stage hepatectomy consisted in a radical resection of sigmoid co]onic carcinoma and left lateral hepatic segment. Subsequently, under the guidance of ultrasonography and radiography, a right portal vein chemoembolization （PVCE） was performed via a percutaneous approach through left portal branch to induce the atrophy of right hemiliver and hypertrophy of left hemiliver. At Week 5 post-PVCE, a second-stage hepatectomy was planned to resect the right hemiliver. For patients with huge hepatocellular carcinoma （HCC）, transcatheter arterial chemoembolization （TACE） were performed and it was followed by PVCE 1 week later. At Week 4 post-PVCE, a right trisegmentectomy was attempted to resect the right liver tumor. The volume of liver was evaluated with three-dimensional CT scan at Weeks 2 and 4 weeks post-PVCE. Results At Week 4 post-PVCE, the atrophy of right lobe was induced and the left lobe underwent compensatory hypertrophy. The remnant volumes of right lobe and right trisegment for HCC decreased from 1380.0 cm3 , 1685.4 cm3 at pre-PVCE to 740.2 cm3 , 1228.1 cm3 at post-PVCE. The values increased from pre-PVCE 435. 1 cm3 , 151.5 cm3 to post-PVCE 624.4 em3 , 560. 2 cm3 for left hepatic lobe remnant of colonic liver metastases and left lateral segment for HCC. The ratios of liver remnant to estimated total liver volume increased from 25.6% , 13.6% at pre-PVCE to 50. 0% , 43.1% post-PVCE respectively. The postoperative course was uneventful. The liver function, serum CEA and AFP decreased to the normal levels. Two patients were followed Up for 18 and 8 months respectively. There was no tumor recurrence. Conclusion PVCE prevents the hepatic function failure after a major hepatectomy. And it may benefit more patients with previously unreseetable liver tumors.

关 键 词：肝肿瘤 结肠肿瘤 门静脉栓塞 化疗 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]