术前选择性门静脉栓塞在肝癌切除术中的应用  

Application of Preoperative Selective Portal Vein Embolization in Hepatocellular Carcinoma Hepatectomy

作　　者：罗志强[1] 邬林泉[1] 邵江华[1] 郭武华[2] 周凡[1] 黄明文[1] 王恺[1] 

机构地区：[1]南昌大学第二附属医院肝胆外科,南昌330006 [2]南昌大学第二附属医院肿瘤科,南昌330006

出　　处：《南昌大学学报（医学版）》2011年第1期38-40,44,共4页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫生厅科技计划(20071057)

摘　　要：目的探讨术前选择性门静脉栓塞(SPVE)对因残余肝脏体积不足而不能手术的原发性肝癌患者肝脏体积的变化和二期手术切除的影响。方法 11例不宜一期手术切除的原发性肝癌患者,在X线数字减影(DSA)引导下经皮经肝细针穿刺行SPVE治疗,观察SPVE的成功率、治疗后不良反应、各肝叶体积及预计残余肝脏与全肝体积比(RLV/TLV)的动态变化、二期手术切除率等指标。结果 11例SPVE均取得成功,门静脉右支栓塞后右肝体积逐步减小,左肝体积逐步增大;术前,术后第1、2和3周时的RLV/TLV分别为34.5%、37.9%、41.6%和45.6%。术后11例均出现一过性的肝功能损害,表现为肝酶升高,4例出现不同程度的肝区隐痛,6例低热。术后第4周,11例均顺利完成了肝癌二期手术切除。治疗期间未发现异位栓塞、肝功能衰竭、出血、胆汁渗漏及感染等并发症,无手术死亡。结论术前SPVE安全、有效,可提高巨大肝癌的手术切除率和手术安全性。Objective To study the effect of preoperative selective portal vein embolization（SPVE） on the changes in liver volume and the second-stage hepatectomy in patients with hepatocellular carcinoma（HCC） who were considered inoperable because of insufficient residual liver volume.Methods Eleven patients with HCC who were not suitable for hepatectomy were treated by DSA-guided percutaneous transhepatic SPVE with fine needles.The rate of success,adverse reactions,the volume of each liver lobe,the ratio of residual liver volume to total liver volume（RLV/TLV）,and hepatectomy rate were observed.Results SPVE was successfully performed in all 11 patients.In patients with right portal vein branch embolization,the right liver volume decreased while left liver volume increased gradually.RLV/TLV increased from 34.5% preoperatively to 37.9%,41.6% and 45.6% at 1,2 and 3 weeks postoperatively.The adverse reactions included hepatic function impairment with transient elevation of hepatic enzyme（11 cases）,different degrees of pain in liver area（4 cases） and lower fever（6 cases）.At postoperative week 4,the second-stage hepatectomy was successfully completed in all patients.No operative mortality and severe complications,such as ectopic embolization,liver failure,bleeding,bile leakage and infection,occured during therapy.Conclusion Preoperative SPVE is a safe and effective procedure,and can increase the indications of hepatectomy for huge HCC and elevate the security of hepatectomy.

关 键 词：原发性肝癌 门静脉栓塞 肝切除 

分 类 号：R735.7[医药卫生—肿瘤]