肝静脉系统栓堵术在第二阶段根治性肝癌切除术中的应用  

Application of liver venous deprivation before two-stage radical hepatectomy in liver cancer patients

作　　者：刘畅[1] 张晓赟[1] 金谌 杨家印[1] 吴泓[1] 王文涛[1] 卢强[2] 李伟[3] 焦河[3] 严律南[1] 文天夫[1] 卢武胜[1] LIU Chang;ZHANG Xiaoyun;JIN Chen;YANG Jiayin;WU Hong;WANG Wentao;LU Qiang;LI Wei;JIAO He;YAN Liinan;WEN Tianfu;LU Wusheng(Department of Liver Surgery/Liver Transplantation Center,National Clinical Research Center for Geriatrics,West China Hospital,Sichuan University,Chengdu 610041,P. R. China;Department of Ultrasound,West China Hospital,Sichuan University,Chengdu 610041,P. R. China;Department of Interventional Radiology,West China Hospital,Sichuan University,Chengdu 610041,P. R. China)

机构地区：[1]四川大学华西医院肝脏外科/肝移植中心,国家老年疾病临床医学研究中心,成都610041 [2]四川大学华西医院超声科,成都610041 [3]四川大学华西医院介入诊疗中心,成都610041

出　　处：《中国普外基础与临床杂志》2019年第7期841-846,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家老年疾病临床医学研究中心(四川大学华西医院)立项资助(项目编号:Z2018B23)

摘　　要：目的初步探讨肝静脉系统栓堵术(liver venous deprivation, LVD)在乙肝背景的肝癌患者第二阶段根治性肝癌切除术中的应用。方法1例术前诊断为中央型肝癌(V、Ⅷ段交界处)的53岁男性患者,因剩余肝脏体积(future liver remnant, FLR)不足无法行标准右半肝切除术,而行LVD术诱导FLR增生。LVD术后1、2及3周评估患者一般情况并复查腹部CT评估FLR体积和剩余肝脏/体质量比。结果患者LVD术前FLR为24.2%,剩余肝脏/体质量比为0.459%;LVD术后第1、2及3周复查FLR,分别为29.5%、38.3%和44.4%,剩余肝脏/体质量比分别为0.545%、0.707%和0.820%.患者于LVD术后第25天顺利施行了标准右半肝切除术,术后安全康复出院。结论LVD可使剩余肝脏体积快速增大,可让预计FLR不足的肝癌患者有接受第二阶段根治性手术治疗的机会,是一项有效诱导FLR增生的新技术。Objective To explore the application of the technique of liver venous deprivation(LVD) for twostage radical hepatectomy in patient with liver cancer underlying hepatitis B virus infection. Methods A 53 years old patient diagnosed with central primary liver cancer(Ⅴ/Ⅷ segment) could not receive standard right hepatectomy since his future liver remnant was insufficient, so the LVD was performed to induce FLR growth. The general condition and CT scan were repeated at 1-, 2-and 3-week after LVD, the FLR and FLR weigh/body weight ratio were calculated. Results The FLR and FLR weight/body weight ratio before LVD were 24.2% and 0.459%, the FLR at 1-, 2-and 3-week after LVD were 29.5%, 38.3% and 44.4% respectively, the FLR weight/body weight were 0.545%, 0.707% and 0.820% at 1-, 2-and 3-week after LVD. The standard right hepatectomy was undertaken successfully at 25 days after LVD and discharged safely.Conclusion The LVD technique could induce a rapid and large FLR volume and offer opportunity for patients with insufficient FLR to receive two-stage radical hepatectomy, is a novel method to induce FLR growth effectively.

关 键 词：肝癌 肝静脉系统栓堵术 二阶段肝切除术 门静脉栓塞 肝静脉栓塞 

分 类 号：R735.7[医药卫生—肿瘤]