术前肝静脉剥夺术同期联合精准肝动脉化疗栓塞在原发性大肝癌二期切除中应用价值研究  

Role of preoperative liver venous deprivation combined with precise hepatic arterial chemoembolization in two-stage hepatectomy for large hepatocellular carcinoma

作　　者：侯昌龙 王继洲 宋瑞鹏 许军 尹大龙 王嘉倍 张树庚 蔡伟[2] 刘连新 HOU Chang-long;WANG Ji-zhou;SONG Rui-peng(Department of Intervention,the First Affiliated Hospital of University of Science and Technology of China,West District,Hefei 230031,China;不详)

机构地区：[1]中国科学技术大学附属第一医院西区介入科,安徽合肥230031 [2]中国科学技术大学附属第一医院肝胆外科肝胆胰外科安徽省重点实验室安徽省肝胆疾病临床医学研究中心,安徽合肥230001

出　　处：《中国实用外科杂志》2022年第6期667-671,共5页Chinese Journal of Practical Surgery

基　　金：国家重点研发计划(No.2019Y FA 0709300);国家自然科学基金(No.U19A2008,No.81972307,No.82170618)。

摘　　要：目的 探讨肝静脉剥夺术(LVD)同期联合精准肝动脉化疗栓塞(TACE)后二期手术切除治疗原发性大肝癌的可行性、安全性和有效性。方法 回顾性分析中国科学技术大学附属第一医院2019年10月至2021年12月因残余肝脏体积不足接受LVD联合精准TACE治疗的12例原发性大肝癌病人临床资料。分析病人LVD联合精准TACE成功率、并发症、肝功能水平、总肝脏体积(TVL)及剩余肝体积(FLR)的变化情况。结果 12例病人介入手术均获得成功,无严重并发症发生,联合栓塞术后丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)均明显升高,术后2 d转氨酶水平达到峰值随后迅速下降,第7天恢复至术前水平。术前FLR为(33.1±6.3)%,术后第1、3周FLR体积比分别为(41.5±16.2)%和(50.0±16.1)%,FLR动态增长率为6.2 mL/d。LVD联合TACE术后3周,9例(75%)病人FLR达到外科手术标准。结论 对于残余肝体积不足的原发性大肝癌病人,术前LVD同期联合精准TACE创伤小、安全性高,对控制肿瘤进展、促进残肝增生、提高手术切除率具有一定价值。Objective To investigate the feasibility,safety and efficacy of liver venous deprivation(LVD)combined with precise hepatic arterial chemoembolization(TACE)followed by two-stage surgical resection for the treatment of large hepatocellular carcinoma. Methods From October 2019 to December 2021 in the First Affiliated Hospital of University of Science and Technology of China,the clinical data of 12 patients with large hepatocellular carcinoma who received LVD combined with precise TACE for conversion therapy due to insufficient residual liver volume were retrospectively analyzed. The success rate,complications,liver function level,total liver volume(TVL)and future liver remnant(FLR)volume of patients with LVD combined with precise TACE were analyzed. Results The operation success rate of 12 patients was 100%,and no serious complications occurred. ALT and AST were significantly increased after combined embolization. The level of transaminase reached the peak on the 2nd postoperative day and then decreased rapidly. On the 7th day,it recovered to the preoperative level,then returned to normal 3 weeks after the operation. The preoperative FLR was(33.1±6.3)%,the FLR at the 1st and 3rd weeks after the operation was(41.5±16.2)% and(50.0±16.1)%,respectively,and the FLR dynamic growth rate was 6.2 m L/d. At 3 weeks after LVD combined with TACE,9 patients(75%)had FLR volume that reached the surgical standard. Conclusion For patients with large hepatocellular carcinoma with insufficient residual liver volume,preoperative LVD combined with precise TACE has less trauma and high safety,and has certain value in controlling tumor progression,promoting residual liver hyperplasia,and improving surgical resection rate.

关 键 词：肝静脉剥夺术 经导管动脉化疗栓塞术 肝细胞癌 剩余肝体积 二期肝切除 

分 类 号：R6[医药卫生—外科学]