肝动脉插管化疗栓塞联合选择性门静脉栓塞后手术切除治疗大肝癌的安全性和有效性观察

Sequential transcatheter arterial chemoembolization and selective portal vein embolization before major hepatectomy for large hepatocellular carcinoma: a pilot study

目的初步探讨经导管肝动脉栓塞化疗(TACE)联合选择性门静脉栓塞(SPVE)后手术切除治疗大肝癌的可行性、安全性和有效性。方法回顾性收集解放军总医院第六医学中心肝胆外科2016年1月至2019年12月完成的17例TACE联合SPVE治疗的大肝癌患者临床资料,其中男性15例,女性2例,年龄(59.17±10.30)岁。分析患者SPVE后与TACE后谷丙转氨酶水平、联合栓塞1个月后肿瘤反应、手术切除患者术后生存情况。结果17例患者中,SPVE术后第1、3天的谷丙转氨酶水平显著高于TACE术后[第1天:191.4(30.5~1966.4)IU/L比125.3(35.7 L~846.2)IU/L,第3天:298.5(24.6~1334.2)IU/L比208.6(21.6~775.6)IU/L],差异有统计学意义(均P<0.05)。联合栓塞术后1个月,肿瘤长径5~10 cm的6例患者中,完全缓解2例(33.3%),部分缓解3例(50.0%),病情稳定1例(16.6%);肿瘤长径>10 cm的11例患者中,完全缓解1例(9.1%),部分缓解4例(36.4%),病情稳定5例(45.5%),病情进展1例(9.1%)。最终11例患者接受了手术评估,治疗前中位残余肝体积329.5(284.9~365.7)ml,经联合栓塞后术前中位残余肝体积415.6(354.7~718.8)ml,中位增生比例28.1%(14.1%~51.3%)。8例患者最终接受了手术切除,围手术期无死亡,中位无瘤生存时间17(7~42)个月,中位生存时间27(7~42)个月。结论对于残余肝体积不足的大肝癌患者,术前TACE联合SPVE对控制肿瘤进展、促进残肝增生、提高手术切除率及改善预后具有一定价值。

Objective To preliminarily study the feasibility,safety and efficacy of transcatheter arterial chemoembolization(TACE)combined with selective portal vein embolization(SPVE)before surgical resection in the treatment of large liver cancer.Methods A retrospective study was conducted on the clinical data of 17 patients with large liver cancer treated with TACE combined with SPVE from January 2016 to December 2019 at the Department of Hepatobiliary Surgery,the Sixth Medical Center of PLA General Hospital.The study included 15 males and 2 females,aged(59.17±10.30)years.The levels of alanine aminotransferase,tumor changes and patient survival were analyzed before operation,after TACE,and after SPVE.Results Among the 17 patients,the levels of alanine aminotransferase on the 1st and 3rd day after SPVE was significantly higher than those after TACE[191.4(30.5-1966.4)IU/L vs 125.3(35.7-846.2)IU/L on the first day,and 298.5(24.6-1334.2)IU/L vs 208.6(21.6-775.6)IU/L on the 3rd day],all P<0.05.One month after the two combined embolism,among the 6 patients with a tumor diameter of 5-10 cm,2 patients(33.3%)had complete remission,3 patients(50.0%)had partial remission,and 1 patients(16.6%)had stable disease.For the tumor’s longest diameter,among the 11 patients with tumors>10 cm,1 patient had complete remission(9.1%),4 patients had partial remission(36.4%),5 patients had stable diseases(45.5%),and 1 patient had disease progression(9.1%).Eventually,11 patients underwent surgical exploration.The median residual liver volume before treatment was 329.5(284.9-365.7)ml,and after the combined procedure 415.6(354.7-718.8)ml.The median hyperplasia ratio was 28.1%(14.1%-51.3%).Eight patients finally underwent surgical resection.There was no death in the perioperative periods.The median tumor-free survival time was 17(7-42)months,and the median survival time was 27(7-42)months.Conclusion For patients with large liver cancer with insufficient remnant liver volume,preoperative TACE+SPVE has certain value in controlling tumor progression,promoting remnant liver hyperplasia,increasing surgical resection rate and improving prognosis.