TACE联合门静脉栓塞术与微波消融肝脏分隔联合门静脉栓塞术治疗剩余肝脏体积不足肝细胞癌的临床疗效  

Clinical efficacy of TACE combined with PVE versus percutaneous microwave ablation liver partition with PVE for planned hepatectomy for hepatocellular carcinoma with insufficient remnant liver volume

作　　者：杨鸿国 胡智明 徐嘉泽 张成武 张军港 尚敏杰 张竝[1] Yang Hongguo;Hu Zhiming;Xu Jiaze;Zhang Chengwu;Zhang Jungang;Shang Minjie;Zhang Bing(Department of Hepatobiliary and Pancreatic Surgery,Zhejiang Provincial Tongde Hospital,Hangzhou 310012,China;Department of Hepato-Biliary-Pancreatic Surgery and Minimal Invasive Surgery,People’s Hospital of Hangzhou Medical College,Zhejiang Provincial People’s Hospital,Hangzhou 310010,China)

机构地区：[1]浙江省立同德医院肝胆胰外科,杭州310012 [2]杭州医学院附属人民医院(浙江省人民医院)肝胆胰外科和微创外科,杭州310010

出　　处：《中华肝胆外科杂志》2023年第6期418-422,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：浙江省中医药现代化专项(2022ZX001);局省共建中医药现代化研究计划重大项目(GZY-ZJ-KJ-23007)。

摘　　要：目的探讨经导管肝动脉栓塞化疗(TACE)联合门静脉栓塞术(PVE)与微波消融肝脏分隔联合PVE治疗剩余肝体积不足肝细胞肝癌的安全性和临床疗效。方法回顾性分析2014年1月至2021年12月浙江省立同德医院及浙江省人民医院收治的51例因剩余肝体积不足初始不可切除肝细胞癌患者的临床资料,其中男性37例,女性14例,年龄(56.7±11.2)岁。依据增肝方式不同分为两组:采用微波消融肝脏分隔联合PVE增肝的患者12例为研究组,采用TACE联合PVE增肝的患者39例为对照组。将上述两组中成功行计划性肝切除术的患者分别作为研究组_(可切除)(n=10)和对照组_(可切除)(n=29)。记录患者手术等待时间、并发症发生情况等临床资料。采用定期门诊或电话随访,记录患者生存情况。采用Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。结果研究组患者的剩余肝体积增生率76.5%(65.3%,81.6%)高于对照组的31.4%(28.2%,41.9%),差异具有统计学意义(P<0.001)。研究组_(可切除)肝切除术等待时长12.0(11.3,14.5)d短于对照组_(可切除)的21.0(15.0,29.0)d,但术后并发症发生率高于对照组_(可切除)[80.0%(8/10)比27.6%(8/29)],差异均具有统计学意义(均P<0.05)。研究组_(可切除)围手术期1例患者死亡,对照组_(可切除)围手术期无死亡患者。研究组患者PVE后生存率差于对照组,研究组_(可切除)患者肝切除术后生存率也差于对照组_(可切除),差异均有统计学意义(均P<0.05)。结论治疗剩余肝脏体积不足肝细胞癌,TACE联合PVE是安全有效的增肝方法,而微波消融肝脏分隔联合PVE虽然可以提高剩余肝体积增生率、缩短肝切除术等待时长,但预后较差。Objective To evaluate the safety and clinical efficacy of transcatheter arterial chemoembolization(TACE)combined with portal vein embolization(PVE)and percutaneous microwave ablation liver partition with PVE for planned hepatectomy in patients with hepatocellular carcinoma(HCC)with insu-fficient remnant liver volume.Methods The clinical data of 51 patients with initially unresectable HCC due to insufficient remnant liver volume admitted to Zhejiang Provincial Tongde Hospital and Zhejiang Provincial People’s Hospital from January 2014 to December 2021 were retrospectively analyzed,including 37 males and 14 females,aged(56.7±11.2)years old.Patients were divided into two groups according to the treatment prior to hepatectomy:percutaneous microwave ablation liver partition combined with PVE(AP group,n=12)and TACE with PVE(TP group,n=39).Patients who successfully underwent planned hepatectomy in the above two groups were marked as resectable AP group(n=10)and the resectable TP group(n=29),respectively.Clinical data including the waiting time for surgery and the incidence of complications were analyzed.Patients were followed up by telephone or outpatient review.Kaplan-Meier and log-rank analysis were used for survival comparison.Results The FLR growth rate was higher in AP group[76.5%(65.3%,81.6%)]than that in TP group[31.4%(28.2%,41.9%),P<0.01].The waiting time for planned hepatectomy in the resectable AP group was 12.0(11.3,14.5)d,shorter than that in the resec-table TP group[21.0(15.0,29.0)d,P<0.05].The incidence of postoperative complications was higher in the resectable AP group than that in the resectable TP group[80.0%(8/10)vs.27.6%(8/29),P<0.05].There was one perioperative death in the resectable AP group.The survival rate after PVE was lower in AP group than that in TP group,and the survival rate after hepatectomy was also lower in the resectable AP group than that in the resectable TP group(all P<0.05).Conclusion For HCC patients with insufficient FLR,TACE combined with PVE is a safe and effective method f

关 键 词：癌 肝细胞 门静脉栓塞术 肝再生 肝实质分隔 计划性肝切除 

分 类 号：R735.7[医药卫生—肿瘤]