超声引导下选择性门静脉栓塞在肝癌二期切除中的应用

Effect of uitrasonic-guided selective portal vein embolization on the two-stage hepatotectomy of patients with primary hepatocellular carcinoma.

目的 探讨超声引导下经皮经肝细针穿刺术前选择性门静脉栓塞 (POSPVE)后对不宜手术切除的肝细胞性肝癌 (HCC)二期切除的可能性。 方法 32例不宜手术切除的HCC患者行超声引导下经皮经肝细针穿刺POSPVE ,观察手术成功率及术后不良反应、各肝叶体积及预计肝切除率的动态变化、二期手术切除率等指标。 结果 手术成功 30例 (93.8% ) ,右侧门静脉支栓塞后右肝体积逐步减少 ,左肝体积逐步增大 ,术前、术后 1w、2w、3w时的预计肝切除率分别为 6 6 .6 %、6 5 .5 %、6 2 .9%、6 0 6 %。术后 2 6例出现不同程度的肝区隐痛 (2 6例 )、低热 (19例 )、恶心呕吐 (7例 )。有程度不同的肝功能减退 ,AST由术前 (44 .6± 5 .3)IU/L ,至术后 1d (5 6 .2± 7.6 )IU/L ,术后 3d (5 1.4± 5 .5 )IU/L ;ALT由术前(5 8.4± 7.4 )IU/L ,至术后 1d (6 2 .8± 9.6 )IU/L ,术后 3d (6 0 .2± 8.5 )IU/L ;TBIL由术前 (14 .6± 5 .3) μmol/L至术后 1d (19.1± 8.6 ) μmol/L ,术后 3d (17.4± 7.7) μmol/L ;PT由术前 (82 .6± 6 .3) % ,至术后 1d (78.6±8.2 ) % ,术后 3d (75 .3± 6 .4 ) %。术后 2w - 4w ,14例 (43.8% )完成了肝癌二期肝切除手术。 结论 超声引导下经皮经肝细针穿刺POSPVE简便易行 。

Objective To study the possibility of ultrasonic-guided preoperative selective portal vein embolization(POSPVE)in the two-stage hepatectomy of primary hepatocellular carcinoma(HCC). Methods 32 patients with HCC who were not suitable for hepatectomy were treated by ultrasonic-guided percuteneous trans hepatic POSPVE with fine needle,hepatectomy rate after the treatment were observed. Results Ultrasonic-guided POSPVE were successively performed in 30 patients(93.8%).In patients with embolized right portal vein branch right liver volume decreased and left liver volume increased gradually.The estimated rarate of hepatectomy decreased from 66.6% before POSPVE to 65.5% after 1w,62.9% after 2w and 60.6%(19/39).The adverse reaction included different degree of pain ofliver area(26/30),lower fever(19/39),nausea and vomiting(7/30).The level of aspartate alanine transaminase increased from (44.6±5.3)IU/L before POSPVE to (56.2±7.6)IU/L after 1d and (51.4±5.5)IU/L after 3d;The level of alanine transaminase increased from (58.4±7.4)IU/Lbefore POSPVE to (62.8±9.6)IU/Lafter 1d and (60.2±8.5)IU/L after 3d;The level of total bilirubin was (14.6±5.3)μmol/L before POSPVE to (19.1±8.6)μmol/L after 1d and (17.4±7.7)μmol/L after 3d;The level of prothrombin time was (82.6±6.3)% before POSPVE to (78.6±8.2)% after 1d and (75.3±6.4)% after 3d.After 2w-4w two-stage hepatectomy for HCC were successively performed in 14(43.8%)patients. Conclusions Ultrasonic-guided percuteneous transhepatic POSPVE extends the indication of hepatectomy of HCC,increase the security of hepatectomy.