经导管肝动脉联合门静脉栓塞在不能手术的原发性肝癌中的应用

Application of Combined Transcatheter Arterial Chemoembolization and Portal Vein Embolization in Inoperable Primary Hepatocellular Carcinoma

目的探讨经导管肝动脉化疗与栓塞(TACE)及门静脉栓塞(PVE)诱导肝叶代偿性增生的可行性和有效性。方法对15例不能切除的晚期肝癌患者,采用碘化油、明胶海绵等栓塞剂经导管行肝右动脉栓塞后2周再行门静脉右支栓塞。PVE术前、术后用CT测量左侧肝叶的体积,观察手术成功率及术后不良反应、肝功能改变、二期手术切除率等指标。结果患者均成功施行TACE及PVE。PVE术前左侧肝叶的体积为(390±116)cm3,术后1周、2周、4周分别为(456±127)cm3、(506±138)cm3、(595±124)cm3,术前、术后肝体积比较,差异有统计学意义(P<0.05)。PVE后2～4周,7例(47%)顺利实行肝癌二期切除术。PVE后未出现严重并发症。结论采用经济实用的碘化油、明胶海绵等栓塞剂经导管TACE及PVE,诱导肝叶代偿性增生在临床上是可行的、有效的,可增加手术切除率及安全性。对于未行手术切除的患者联合栓塞后有利于进一步治疗。

Objective To investigate the feasibility and effectiveness of transcatheter arterial chemoembolization （TA- CE） combined with portal vein embolization （PVE） in inducing compensatory hypertrophy of liver lobes. Methods A total of 15 patients with inoperable primary bepatocellular carcinoma （HCC） were treated with TACE and then PVE two weeks later. The vol＊ umes of left liver lobe were measured with CT before and after PVE. The success rate, adverse reactions, changes of hepatic func- tion, hepatic lobe volume and hepatectomy rate were determined. Results TACE and PVE were successfully performed in 15 pa- tients. The left liver volume increased from （390 ＋ 116） cm3 preoperatively to （456 ＋ 127） cm3, （506 ＋ 138） em3 and （595 ＋ 124） cm3 in 1, 2 and 4 weeks respectively after PVE. The difference of the live volume before and after PVE was statistically significant （P 〈0. 05） . Two to four weeks after PVE, hepatectomy was successfully performed on 7 patients （46. 7% ） . No se- vere complications occurred after PVE. Conclusion PVE combined with TACE is safe and effective in increasing volume of non - embolized liver by using lipiodol and gelatin sponge. It increases the success rate of hepatectomy for HCC and can improve the security of hepatectomy. It is also valuable for patients without operation to have further treatment.