NBCA组织胶与PVA微球联合弹簧钢圈在肝门部胆管癌术前PVE中的应用对比  

A Comparative Study on Preoperative Portal Vein Embolization for Perihilar Cholangiocarcinama using N-butyl Cyanoacrylate Versus Polyvinyl Alcohol Plus Coils

作　　者：黄剑 葛乃建 徐伟 蔡飞 张小锋 周静 杨业发 HUANG Jian;GE Naijian;XU Wei(Department of Interventional Radiology,Shanghai Eastern Hepatobiliary Surgery Hospital,Shanghai 200438,P.R.China)

机构地区：[1]海军军医大学附属东方肝胆外科医院放射介入科,上海200438

出　　处：《临床放射学杂志》2021年第10期1993-1999,共7页Journal of Clinical Radiology

摘　　要：目的探究氰基丙烯酸正丁酯(NBCA)组织胶对比聚乙烯醇(PVA)微球联合弹簧钢圈在肝门部胆管癌术前门静脉栓塞(PVE)中促进预保留肝体积(FLR)增生的效果。方法回顾性分析2017年1月至2020年6月收治于东方肝胆外科医院肝门部胆管癌行术前PVE的63例患者临床资料,根据栓塞材料分为NBCA组26例及PVA联合弹簧钢圈组37例。比较两组患者FLR体积增加值(FLR_(PVE后)-FLR_(PVE前))、FLR体积增生率[(FLR_(PVE后)-FLR_(PVE前))/FLR_(PVE前)]、FLR体积增生速度(FLR体积增加值/PVE后天数)、FLR增生度[FLR_(PVE后)/总肝体积(TLV)-FLR_(PVE前)/TLV]、PVE术后并发症、胆管癌根治手术率、术后并发症、围手术期死亡率及术后90天内死亡率。结果NBCA组PVE术后(24.39±10.11)天FLR体积增加值(219.36±82.87)ml,PVA组PVE术后(26.16±11.79)天FLR体积增加值(154.74±121.57)ml(P=0.022)。NBCA组及PVA组FLR体积增生率分别为(47.96±23.28)%、(25.23±20.20)%(P<0.001),FLR体积增生速度分别为(10.91±6.39)ml/天、(6.79±6.85)ml/天(P=0.019),FLR增生度分别为(12.19±5.11)%、(9.18±5.02)%(P=0.023)。两组患者PVE术后并发症、胆管癌根治手术率及术后并发症均无明显统计学差异(P=0.457、P=0.317、P=0.551)。肝门部胆管癌根治术围手术期死亡PVA组2例(P=0.205),术后90天内NBCA组及PVA组各1例患者死亡(P=0.853)。结论NBCA及PVA联合弹簧钢圈PVE均可有效促进肝门部胆管癌术前FLR增生,且NBCA促进FLR增生效果优于PVA联合弹簧钢圈。Objective The aim of this study was to retrospectively compare the results of preoperative portal vein embolization(PVE)using N-butyl cyanoacrylate(NBCA)with polyvinyl alcohol(PVA)spherical microparticles plus coils in high-risk resections for perihilar cholangiocarcinoma.Methods From January 2017 to June 2020,63 consecutive patients with preoperative PVE and Perihilar cholangiocarcinoma were enrolled into this study.The patients were divided to receive PVE using NBCA(the NBCA group,n=26)and PVE using PVA spherical microparticles plus coils(the PVA group,n=37).The increase of future liver remnant(FLR)volume,percentage of proliferation,proliferation rate,hyperplasia,post-PVE complications,postoperative complications and mortalities were compared between the two groups.Results All patents in the two groups had successful PVE.The increase of FLR volume during 24.39±10.11 days after PVE was(219.36±82.87)ml in the NBCA group and(154.74±121.57)ml during 26.16±11.79 days after PVE in the PVA group(P=0.022).The percentage of proliferation in NBCA group and PVA group was(47.96±23.28)%and(25.23±20.20)%,respectively(P<0.001).The proliferation rate of FLR in NBCA group and PVA group was 10.91±6.39 mL/day and 6.79±6.85 mL/day,respectively(P=0.019).The hyperplasia of FLR in NBCA group and PVA group was(12.19±5.11)%and 9.18±5.02,respectively(P=0.023).There were no significant differences in post-PVE complications,resection rate of perihilar cholangiocarcinoma and postoperative complications between the 2 groups(P=0.457,P=0.317,P=0.551).Two patients died related to resection of hilar cholangiocarcinoma in the PVA group(P=0.205),and one patient died within 90 days after resection in the NBCA group and in the PVA group,respectively(P=0.853).Conclusion NBCA and PVA spherical microparticles plus coils are both effective to induce left-lobe hypertrophy in perihilar cholangiocarcinoma,and NBCA seems have a better degree of hypertrophy of FLR compared to PVA spherical microparticles plus coils.

关 键 词：氰基丙烯酸正丁酯组织胶 聚乙烯醇微球 肝门部胆管癌 门静脉栓塞 预保留肝体积 

分 类 号：R735.8[医药卫生—肿瘤]