肝静脉-门静脉联合栓塞术促进预留肝脏快速增生——结直肠癌肝转移转化切除新策略  

Combined hepatic and portal vein embolization induce fast hypertrophy of future liver remnant: new strategy of conversion therapy for initially unresectable colorectal liver metastases

作　　者：王晓颖[1] 瞿旭东[1] 许剑民[1] 韦烨[1] 张雯[1] 高强[1] 胡捷[1] 蔡加彬[1] 周俭[1] 樊嘉[1] WANG Xiao-ying;QU Xu-dong;XU Jian-min(Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院,上海200032

出　　处：《中国实用外科杂志》2022年第6期672-679,共8页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.82090054);上海市申康医院发展中心重大临床研究项目(No.SHDC2020CR3004A)。

摘　　要：目的 评价肝静脉-门静脉联合栓塞术(HVE+PVE)安全性、促进预留肝脏增生的能力及联合系统治疗用于初始不可切除结直肠癌肝转移(CRLM)转化切除的可行性。方法 回顾性分析2020年12月至2021年11月复旦大学附属中山医院3例肝左、右叶多发初始不可切除CRLM病例经系统治疗后,病灶缩小,但剩余肝体积(FLR)不足,行HVE+PVE后转化切除的临床资料。结果 HVE+PVE后平均18.6 d,FLR从平均423.6 mL增生至561 mL,平均增长率32.8%;剩余肝体积(FLR)/标准肝体积(SLV)从平均33.5%增至43.8%,无并发症发生。HVE+PVE后平均23 d行右半肝+左肝部分切除术等,平均出血333.3 mL,未输血。术后无Clavien-DindoⅢ级以上并发症,无肝功能衰竭及90 d死亡。均获得R0切除。平均11.3 d出院。结论 HVE+PVE通过介入操作即可使FLR快速增生,具有操作简捷、创伤小、安全等优点。联合系统治疗可以增加初始不可切除CRLM的转化切除率。Objective To assess the safety and efficacy of combined hepatic and portal vein embolization(HVE+PVE)to induce hypertrophy of future liver remnant(FLR),and improvement of conversion therapy for initially unresectable colorectal liver metastases(CRLM).Methods The clinical data of 3 cases with initially unresectable CRLM underwent conversion therapy by HVE + PVE after systemic therapy between December,2020 and November,2021 at Zhongshan Hospital,Fudan University were analyzed retrospectively. These 3 cases showed partial response after systemic chemotherapy and targeted therapy,however,FLR was insufficient for extended resection. Results HVE+PVE was safely performed in 3 cases without complication.At a mean of 18.6 days after HVE+PVE,FLR increased 32.8 %,from 423.6 m L to 561 mL,FLR/SLV increased from 33.5% to 43.8%.3 cases underwent extended hepatectomy at a mean of 23 days after HVE+PVE.Mean operative blood loss was 333.3 mL,and blood transfusion rate was 0.The R0 resection rate was 100%.There was no major postoperative complication(>ClavienDindo gradeⅢ),liver failure and 90 d mortality.The mean hospital stay was 11.3 days.Conclusion HVE+PVE is a simple,safe and minimally invasive interventional technique,which induces fast hypertrophy of FLR.Combination of HVE+PVE and systemic therapy will increase the conversion rate of initially unresectable CRLM.

关 键 词：肝静脉 门静脉 栓塞 治疗性 结直肠癌肝转移 转化治疗 

分 类 号：R6[医药卫生—外科学]