肝门部胆管癌术前行门静脉栓塞16例分析

Preoperative portal vein embolization for hilar cholangiocarcinoma: a report of 16 cases

目的探讨未来残余肝较小的肝门部胆管癌病人行门静脉栓塞是否安全有效。方法对2007年1月至2009年3月第二军医大学附属东方肝胆外科医院拟行大部肝切除、未来残余肝/全肝体积(FLR/TLV)比<50%的16例接受钢圈门静脉栓塞(portal vein embolization,PVE)的临床资料进行分析。结果术前16例(PVE组)因肝功能损害、FLR/TLV<50%者行PVE治疗,33例(非PVE组)FLR/TLV>50%者行肿瘤联合肝切除。PVE后3例出现并发症,原因为胆漏和钢圈移位,但未推迟肝切除术日期。16例PVE中1例合并肝硬化出现非栓塞肝叶增生不全而未能接受外科治疗,2例术中发现肿瘤进展、腹膜播散未能接受肝切除术,余13例(81.3%)行联合肝切除的肿瘤切除术。PVE组和非PVE组的手术并发症发生率分别为69.2%及63.6%,手术死亡率为0及9.1%。二者相比差异无统计学意义。结论 PVE能安全、有效地诱导肝门胆管癌术前未来残余肝增生。

Objective To evaluate whether portal vein embolization （PVE） is safe and efficacious in patients with hilar cholangiocarcinoma who are estimated to have inadequate/marginal future liver remnant （FLR）. Methods Between January 2007 and March 2009 at Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, 16 cases of FLR ratio 〈50% requiring major hepatectomy underwent PVE with multiple steel coils. Results Sixteen cases （PVE group） were performed PVE resulted from hepatic function injury and FLR ratio 〈50%. Thirty-three cases （nonPVE group） were performed extended hepatectomy en bloc with the tumor resulted from FLR ratio 〉50%. PVE complications including bile leak （1/16） and coil displacement （2/16） did not delay hepatectomies. Deficiency of FLR hypertrophy appeared in one case with underlying cirrhosis and prevented him away from surgery. Local tumor progression and peritoneal dissemination precluded hepatectomy in 2 cases. The other 13 cases （81.3%） underwent extended hepatectomy en bloc with the tumor. The PVE hepateetomy group （n=13） had similar complication and mortality rates compared with the non-PVE hepatectomy group （FLR ratio 〉 50%, n=33） （complication rate, 69.2% vs. 63.6%, P=1.000; mortality rate, 0 vs. 9.1%, P=0.548）. Conclusion PVE is a safe and efficacious procedure in inducing adequate hypertrophy of the FLR before major hepatic resection for hilar cholangioearcinoma.