末梢门静脉栓塞术在计划性肝切除术中的应用初探

Terminal branches portal vein embolization for planed hepatectomy

目的 初步探讨末梢门静脉栓塞术（TBPVE）在计划性肝切除术中的应用效果.方法 2016年2-6月,由同一手术组分别在汕头大学附属粤北人民医院（n=3）和江西省吉安市中心人民医院（n=1）对4例肝细胞癌患者实施TBPVE联合肝切除术.4例患者均为男性,年龄分别为50、64、39、47岁.患者肿瘤均位于右半肝,术前肝功能均为Child-Pugh A级,肝硬化程度均为G2S4.应用4例患者的CT扫描数据进行肝脏三维重建,标准肝脏体积（SLV）分别为1 291、1 109、1 177、1 242 ml,预计术后剩余肝脏体积（FLR）为315、347、306、323 ml.按照门静脉三维成像模型确定TBPVE方案.3例以右侧肝脏6段为穿刺点,1例以左侧肝脏3段为穿刺点进行TBPVE.TBPVE后1、2周复查CT,计算FLR和FLR/SLV.4例患者在TBPVE后2周行右半肝切除术.结果 4例患者TBPVE后14 d FLR分别为529、462、469、498 ml,较术前相比分别增加了67.9％、33.1％、53.3％、54.2％;术后14 d FLR/术前SLV分别为41.0％、41.7％、39.8％、40.1％.未发生严重并发症.4例患者在TBPVE后2周均成功接受右半肝切除术,断肝时未阻断肝蒂,平均出血量950 ml,手术时间3～4h,平均3.3h.1例术后因呼吸道感染发热1周,2例术后出现短暂性黄疸、腹水,无其他手术并发症.结论 TBPVE可使肝脏体积快速增大,可能让预计FLR不足的肝细胞癌患者有接受手术治疗的机会.

Objective To explore the application of the technique of terminal branches portal vein embolization（TBPVE）for planed hepatectomy.Methods From February 2016 to June 2016,4 patients with hepatocellular carcinoma underwent TBPVE and liver resection in Yuebei People＇s Hospital （n =3） and Jiangxi Ji＇an Central People＇s Hospital （n =1）.All of them were male and were 50,64,39 and 47 years old respectively.All the tumors located in the right lobe.All patients had the liver function of Child-Pugh A classification and liver cirrhosis level of G2S4.The standard liver volume （SLV） were 1 291,1 109,1 177 and 1 242 ml and estimated future liver remnant（FLR） were 315,347,306 and 323 ml respectively.The puncture site of TBPVE was determined by the three-dimensional reconstruction of portal vein.Three patients were punctured in the segment Ⅵ and the other one punctured in the segment Ⅲ.CT scan was repeated 2 weeks after TBPVE and FLR and FLR/SLV were calculated.All patients underwent right hepatectomy 2 weeks after TBPVE.Results On the 14th day after TBPVE,the FLR of 4 patients were 529,462,469 and 498 ml which increased 67.9%,33.1%,53.3% and 54.2% compared with that before TBPVE,and FLR/ SLV were 41.0%,41.7%,39.8% and 40.1% respectively.No severe complication occurred.Right hepatectomy were performed 2 weeks after TBPVE.No inflow blood control applied during the liver resection.The mean blood loss was 950 ml and the mean operating time was 3.3 hours （ranging from 3 to 4 hours）.One patient had respiratory infection and two had slight jaundice and ascites for a short period.No other complication occurred.Conclusion The TBPVE could induce a rapid and large FLR volume that give chances to patients with small FLR to have liver resection for hepatocellular carcinoma.