门静脉栓塞术在肝胆肿瘤手术治疗中的临床应用

Outcomes of liver resections with preoperative portal vein embolization for hepatobiliary neoplasms

目的探讨门静脉栓塞术在肝胆肿瘤手术治疗中的应用价值。方法回顾2017年1月1日至2019年5月31日我院收治的所有诊断为肝胆肿瘤且术前行门静脉栓塞术(PVE)的病例,比较患者行PVE前后残余肝体积(FLR)及残余肝体积与标准肝体积(SLV)比值(FLR/SLV)的变化,分析门静脉栓塞术对手术相关指标及患者预后情况的影响。结果本次研究共纳入了12例病人,他们PVE术前平均FLR为374.96±48.77 mL,术后平均FLR为518.47±102.98 mL,平均增加了145.70±75.81 mL(P<0.001);术前FLR/SLV平均为(32.06±4.01)%,术后FLR/SLV平均为(44.45±8.54)%,平均增加了(12.44±6.3)%(P<0.001)。病人PVE后等待时间平均为31.2±9.53天,其中9例进行了根治性手术,7例达到了R0切除,共1例病人出现了术后并发症(Ⅲa级)。结论门静脉栓塞术可以显著增加患者残余肝体积,使原本无法耐受手术的肝胆肿瘤患者获得手术机会,提高根治性手术率及R0切除率,减少术后肝衰竭的发生,同时可以降低术后并发症发生率,有助于改善患者预后。

Objective To explore the application value of portal vein embolization technique in hepatobiliary surgery.Methods We retrospectively recalled all patients that have underwent preoperative portal vein embolization and diagnosed as hepatobiliary tumor from January 1 st 2017 to May 31 st 2019,and collected basic characteristics and perioperative data of them.Through comparing the change of future liver remnant(FLR) and the ratio of future liver remnant to total liver volume(FLR/TLV) before and after the portal vein embolization,we tried to analyze the influence of PVE on surgical indicators and patient prognosis.Results Twelve patient were included.The mean FLR before PVE was 374.96±48.77 ml,and the mean FLR after PVE was 518.47±102.98 mL with an increase of 145.70±75.81 mL,P<0.001).The mean FLR/TLV before PVE was(32.06±4.01)%,and the mean FLR/TLV after the PVE was(44.45±8.54) % with an increase of(12.44±6.3)%(p<0.001).Nine patients underwent radical surgery,seven patients achieved the RO resection,and only two patients have experienced obvious postoperative complications.Conclusion Portal vein embolization could significantly improve the future liver remnant,provide surgical opportunity for more patients and improve the radical surgery rate and RO resection rate.Moreover,it could also reduce the occurrence of postoperative liver failure,decrease the postoperative complication rate and increase the prognosis of patients.