TACE联合PVE行腹腔镜右半肝切除术在巨大肝癌治疗中的应用  

Transcatheter arterial chemoembolization and portal vein embolization prior to scheduled laparoscopic right hemihepatectomy for patients with large liver tumor

作　　者：刘杰[1] 张成武[1] 张宇华[1] 张军港[1] 吴伟顶[1] 胡智明[1] Liu Jie;Zhang Chengwu;Zhang Yuhua;Zhang Jungang;Wu Welding;Hu Zhiming(Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China)

机构地区：[1]浙江省人民医院肝胆胰外科及微创外科,310014

出　　处：《中华普通外科杂志》2019年第5期421-424,共4页Chinese Journal of General Surgery

基　　金：浙江省医药卫生科技基金资助项目(2016KYA009)。

摘　　要：目的探讨经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合门静脉栓塞(portal vein embolization,PVE)的计划性腹腔镜右半肝切除术治疗巨大肝癌的疗效。方法分析TACE联合PVE后实施计划性腹腔镜右半肝切除术8例患者的临床资料,序贯联合和同期联合各4例。结果序贯组中TACE与PVE的间隔时间为14~29d,PVE与手术间隔时间为13.30d。同时组中TACE联合PVE与手术间隔时间为19.30d。肝酶均有一过性升高,但在手术前均恢复至基本正常水平。8例患者标准剩余肝体积(standard future liver remnant,sFLR)从入院时的平均35.3%±4.9%增加到肝切除术前的48.7%±5.1%,均顺利实施计划性腹腔镜右半肝切除术,无中转开腹;无围手术期死亡,术后并发症2例,分别为肺部感染和胆漏,保守治疗治愈,中位住院时间36d。8例患者术后均获随访,中位随访时间25个月。随访期间患者均存活,2例复发,均带瘤生存。结论TACE联合PVE计划性腹腔镜右半肝切除术治疗肝癌是安全可行的。Objective To explore the value of transcatheter arterial chemoembolization ( TACE ) combined with portal vein embolization ( PVE) prior to laparoscopic right hemihepatectomy ( LRH) in the treatment of large liver tumor. Methods A retrospective study was conducted based on the clinical data of 8 patients with large liver tumor undergoing PVE combined with TACE before scheduled LRH, with 4 cases receiving simultaneous TACE + PVE and the other 4 cases doing sequential TACE + PVE. Results The interval between TACE and PVE was 14 - 29 d in sequential group, and the interval between PVE and surgery was 13 - 30 d. Patients in simultaneous treatment group encountered more prominent elevation of transaminase after PVE and TACE, but they recovered to comparable levels with the sequential group before surgery. The average standard future liver remnant ( sFLR) increased from 35. 3%± 4. 9% to 48. 7%± 5. 1% before surgery. LRH was performed sucessfully in all patients with no conversion and perioperative death. Complications occurred in 2 cases, including pulmonary infection and bile leakage. The median hospital stay was 36 days. All patients were survival in the 25 months median follow up time including 2 recurrence cases. Conclusions TACE combined with PVE prior to LRH in the treatment of large liver tumor is safe and feasible.

关 键 词：肝肿瘤 肝切除术 化学栓塞 治疗性 

分 类 号：R735.7[医药卫生—肿瘤]