选择性门静脉栓塞术在原发性肝癌治疗中的应用

The Method of Applying Selective Portal Vein Embolization in the Primary Hepatic Carcinoma Patients

目的：研究选择性门静脉栓塞术（SPVE）在原发性肝癌治疗中的作用。方法：对5例不宜一期手术切除的中晚期肝癌患者先行SPVE，待肝功能恢复≥Child B级后，再行原发性肝癌二期切除术。观察SPVE成功例数、SPVE术后不良反应、栓塞前后肝叶体积变化、肝癌二期切除术病例数、术后肿瘤复发情况等。结果：SPVE共成功3例，其中2例行SPVE，1例行SPVE联合肝动脉栓塞化疗。1例患者SPVE后出现肝区隐痛不适。接受SPVE联合肝动脉栓塞化疗患者的肝功能降至Child C级，护肝治疗4周仍元改善。另2例SPVE成功的病例出现程度不同的肝功能减退，予护肝治疗2—3周后肝功能达Child B级。全部病例均未出现异位栓塞、局部出血、胆漏等并发症。SPVE后，栓塞侧肝叶体积渐缩小，非栓塞侧肝叶体积渐增大。SPVE后第2周时，栓塞侧肝叶体积较栓塞前缩小20．2％～32．8％，非栓塞侧肝叶体积增加28．2％～42．5％。2例SPVE成功的患者施行了肝癌二期切除术，术后恢复良好元并发症。接受肝癌二期切除术的2例患者分别于术后第6、17月出现肝癌肝内复发，术后第8、20月死亡。结论：SPVE较安全，它可扩大肝癌肝切除术的适应症，提高肝癌二期切除术的手术安全性。

Objective：Researching the effect of applying selective portal vein embolization （SPVE） in the primary hepatic carcinoma patients. Methods：5 primary hepatic carcinoma patients who need stage Ⅱ hepatectomy were collected. SPVE was applied before the operation. The stage Ⅱ hepateetomy continued when the hepatic function recovered no less than Child B degree. The cases of successful SPVE, the side effect of SPVE, the liver volumn before and after SPVE, the eases of stage Ⅱ hepateetomy, and the recurrence of tumor were observed. Results： SPVE was successful in 3 eases. One case was treated by SPVE and transeatheter hepatic arterial ehemoembolization, the other two were treated by SPVE, Stomachache occurred in 1 ease. In the patient treated by SPVE and tran- seatbeter hepatic arterial chemoembolization, the hepatic function remained in Child C degree even after 4 weeks＇ liver - protecting measurement. In the other two eases treated by SPVE, the hepatic function were improved to Child B degree after 2 ～ 3 weeks＇ liver - protecting measurement. Ectopia embolism, regional hemorrhage and bile leaking were not occurred in the 5 cases. The volumn of hepatic lobes reduced in the embolized side, while increased in the other side. 2 weeks after SPVE, the volumn of hepatic lobes reduced 20.2% ～ 32.8% in the embolized side, while increased 28.2% ～ 42.5% in the other side. The stage Ⅱ bepatectomy continued in 2 cases with successful SPVE, and the 2 patients recovered satisfactorily after the operation. In the 2 eases with stage Ⅱ hepateetomy, the tumor recurrence time was 6 and 17 months, the survival time was 8 and 20 months. Condusion：SPVEis quite safe,It can improve the safety of stage Ⅱ hepateetomy.