肝动脉化学疗法栓塞联合选择性门静脉栓塞在肝癌二期切除术中的应用  

Application of transcatheter arterial chemoembolization combined with selective portal vein embolization in two-stage hepatectomy of hepatocellular carcinoma

作　　者：周坦洋[1] 孙军辉[1] 张岳林[1] 聂春辉[1] 李琚[1] 周官辉[1] 朱统寅[1] 王伟林[1] 郑树森[1] 

机构地区：[1]浙江大学附属第一医院肝胆胰介入诊治中心,杭州310003

出　　处：《中华消化杂志》2014年第9期582-588,共7页Chinese Journal of Digestion

基　　金：国家传染病重大专项（2012ZX10002-017）;国家自然科学基金（81371658、81172515/H1617）;国家自然科学基金青年基金（30901446）;浙江省医药卫生科研项目（2013KYB097）

摘　　要：目的探讨经导管肝动脉化学疗法栓塞（TACE）联合选择性门静脉栓塞（SPVE）治疗在肝癌二期切除术中的应用价值。方法纳入2010年9月至2013年9月采用 TACE 或 TACE 联合SPVE 治疗的不能行一期手术切除的右肝癌患者107例。其中采用 TACE 治疗的55例，采用 TACE 联合 SPVE 治疗的52例。观察治疗成功情况与患者的并发症、不良反应、各肝叶体积变化和肝癌手术切除率。计数资料比较采用卡方检验，计量资料比较采用 t 检验。结果107例肝癌患者均顺利完成TACE或 TACE 联合 SPVE 治疗，技术成功率为100％。治疗期间所有患者均未出现异位栓塞、肝功能衰竭、穿刺道出血、消化道出血、胆漏和肝脓肿等并发症。治疗后不良反应主要有肝功能损伤，肝区胀痛，发热，恶心、呕吐等。治疗后4周，TACE 组与 TACE 联合 SPVE 组肝癌患者右肝及肿瘤体积均有不同程度的萎缩，而 TACE 组患者左肝体积无明显变化，TACE 联合 SPVE 组患者左肝体积明显增大。TACE 组与 TACE 联合 SPVE 组患者治疗前的预计残余肝体积（RLV）分别为（404.0±46.3）cm^3和（393．9±65．7）cm^3，差异无统计学意义（t＝0．927，P ＝0．356），治疗后4周的预计 RLV 分别为（415．4±45．7）cm^3和（567．3±88．7）cm^3，差异有统计学意义（t＝-11．219，P ＜0．05）。随访3～6个月，TACE组与 TACE 联合 SPVE 组患者手术切除率分别为38．2％（21/55）和86．5％（45/52），差异有统计学意义（χ^2＝26．440，P ＜0．01）。结论对于不能行一期手术切除的肝癌患者在术前采用 TACE 联合 SPVE治疗，能有效控制肿瘤生长，缩小肿瘤体积，增加 RLV，从而提高二期手术切除率。Objective To explore the application of transcatheter arterial chemoembolization （TACE） combined with selective portal vein embolization （SPVE ） in two-stage hepatectomy of hepatocellular carcinoma （HCC）.Methods From September 2010 to September 2013,a total of 107 patients with HCC in the right liver lobe who were not suitable for one stage hepatectomy received TACE or TACE combined with SPVE treatment were enrolled.Among them,55 received TACE therapy and 52 accepted TACE combined with SPVE treatment.The technique success rate,complication,adverse reactions,the volume change of each liver lobe and the rate of hepatectomy of HCC were observed.Chi-square test was used for numerical data comparison and Student′s t test for measurement data.Results TACE or TACE combined with SPVE therapy was successfully applied in all the 107 patients,the technique success rate was 100%.During treatment period,no complications such as ectopic embolization, liver function failure,puncture tract bleeding,gastrointestinal bleeding,bile leakage and hepatic abscess were observed.After treatment,the adverse reactions included liver function impairment,pain in hepatic region,fever,nausea and vomiting.Four weeks after the treatment,the volumes of tumor and right liver lobe decreased to certain degree in patients with HCC of both TACE group and TACE combined with SPVE group.The volume of left liver lobe in TACE group had no obvious change,while remarkably increased in TACE combined with SPVE group.The pre-treatment residual liver volume （RLV）of TACE group and TACE combined with SPVE group was （404.0 ± 46.3 ）cm^3 and （393.9 ± 65 .7 ）cm^3 , respectively,and the difference was not statistically significant （t=0.927,P =0.356）.Four weeks after the treatment,RLV was （415.4 ±45.7 ）cm^3 and （567.3 ±88.7 ）cm^3 ,respectively,and the difference was statistically significant （t= -11 .219,P 〈0.05）.Patients were followed up for three to six months,the rates of hepatectomy were 38.2%（21/55）and 86.5 %（45

关 键 词：肝肿瘤 介入 栓塞 门静脉 二期手术 

分 类 号：R735.7[医药卫生—肿瘤]