肝癌合并肝硬化患者行同期超选择性肝动脉栓塞和门静脉栓塞的二步肝切除术的可行性探讨  

Feasibility of two-step hepatectomy of superselective hepatic artery embolization and portal vein embolization for patients with liver cancer complicated with cirrhosis

作　　者：蔡旺 李宾[1] 张雁征 CAI Wang;LI Bin;ZHANG Yan-zheng(Department of Minimally Invasive Oncology,Tangshan People's Hospital,Tangshan Hebei 063000,China;Department of Third Internal Medicine,Tangshan Third Hospital,Tangshan Hebei 063000,China)

机构地区：[1]唐山市人民医院微创肿瘤科,河北唐山063000 [2]唐山市第三医院内三科,河北唐山063000

出　　处：《临床和实验医学杂志》2020年第8期866-870,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省卫生和计划生育委员会科研基金项目(编号:20171285)。

摘　　要：目的 探讨肝癌合并肝硬化患者行同期超选择性肝动脉栓塞术(PVE)和门静脉栓塞(SHAE)的二步肝切除术的可行性。方法 回顾性分析2016年10月至2017年10月唐山市人民医院收治的6例肝癌合并肝硬化患者的临床资料,采用同期超选择性PVE+SHAE进行治疗。对手术相关指标[手术时间、手术出血量、肝功能相关指标水平、术后剩余肝脏体积(FLR)水平]进行分析;对术后随访情况进行分析。结果 ①一期手术结果。手术时间为85~145 min,平均(112. 32±12. 23) min;患者术后3 d时均存在不同程度的发热症状,经物理降温后可恢复至正常水平。患者术后肝功能均出现一定变化,丙氨酸氨基转移酶(ALT)峰值为190~4 203 U/L,平均(1 782. 30±55. 69) U/L;术后总胆红素(TBil)峰值为22~40. 2μmol/L,平均(30. 98±3. 46)μmol/L。一期术后7~16 d FLR水平升高了149. 2 ml,每日平均升高(16. 2±3. 23) ml。例如:第4例患者术前左半肝体积为342 ml,经治疗后15 d,左半肝体积增生至545 ml,增幅高达59. 36%,这个指标完全达到了第2步手术的需求;第5例患者经治疗后15 d,左半肝体积也显著增大。②二期手术结果。于一期术后7~17 d实施二期手术,手术时间为185~430 min,平均(259. 29±19. 87) min;失血量为220~1 380 ml,平均(665. 49±21. 12) ml;2例患者TBil水平于术后2周升至385. 29μmol/L,经护肝退黄治疗以及一次性人工肝治疗,TBil水平逐渐降低,术后33 d TBil降至正常水平。6例患者中,治疗后有5例患者甲胎蛋白(AFP)水平在3个月之内降至正常水平。③术后随访7~20个月,平均(12. 09±2. 32)个月,截至发稿时仍然有3例存活患者,且其中有2例患者为无瘤生存,剩下的1例于术后7个月时检查发现肝内复发以及骨转移,目前带瘤生存。术后病理检查结果均为原发性肝癌,肿瘤最大直径为(11. 76±1. 25) cm,门静脉癌栓、肝静脉癌栓各1例,微血管侵犯程度为M0~M2型,其中M0、M1、M2型分别为1、3�Objective To investigate the feasibility of two-step hepatectomy of superselective hepatic artery embolization and portal vein embolization(SHAE+PVE)for patients with hepatocellular carcinoma complicated with cirrhosis.Methods The clinical data of six cases of patients with hepatocellular carcinoma complicated with cirrhosis admitted to Tangshan People's Hospital from October 2016 to October 2017 were retrospectively analyzed.They were treated by PVE+SHAE.The indexes related to the operation(operation time,blood loss,liver function related index and residual liver volume(future liver remnant,FLR))were analyzed.The postoperative follow-up of this group of patients was also analyzed.Results①Results of the first-stage operation.The operation time of the 6 patients ranged from 85 to 145 minutes,with an average of(112.32±12.23)minutes.All patients had fever symptoms of varying degrees at 3 days after the operation,and after physical cooling they returned to normal.Liver function of all patients changed after the operation.The peak value of Alanine transaminase(ALT)was 190~4203 U/L,with an average value of(1782.30±55.69)U/L.The peak value of Total bilirubin(TBil)was 22~40.2μmol/L,with an average of 30.98±3.46μmol/L.The FLR level increased by 149.2 ml from 7 to 16 days after the first operation,with an average of(16.2±3.23)ml per day.For example,the left liver volume of the fourth patient before surgery was 342 ml,and after 15 days of treatment,the volume of the left liver increased to 545 ml,with an increase of 59.36%,which fully met the needs of step 2 operation;In the fifth patient,the left liver volume also increased significantly after 15 days of treatment.②Results of the second-stage operation.All patients in this study underwent the second-stage operation 7 to 17 days after the first-stage operation.The operation time was 185 to 430 minutes,with an average of(259.29±19.87)min.The blood loss was 220 to 1380 ml,with an average of(665.49±21.12)ml;TBil level of the 2 patients increased to 385.29μmol/L 2

关 键 词：肝癌合并肝硬化 超选择性肝动脉栓塞 门静脉栓塞 二步肝切除术 

分 类 号：R735.7[医药卫生—肿瘤] R575.2[医药卫生—临床医学]