ALPPS与采用不同栓塞材料PVE对肝再生及手术切除率影响研究

Effects of ALPPS and PVE with different embolization materials on liver regeneration and surgical resection rate

目的比较不同栓塞材料的门静脉栓塞术(PVE)与联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)对剩余肝体积(FLR)增长速率的影响,比较各组FLR的增长速率,二期手术切除率、术中数据和术后并发症。方法采用单中心、前瞻性、非随机对照的对比研究。2014年11月至2019年12月,海军军医大学第三附属医院共126例因FLR不足导致无法切除的肝细胞癌(HCC)或肝内胆管癌(ICC)病人,将其分为4组:ALPPS组及分别采用氰基丙烯酸正丁酯(NBCA)、微球、明胶海绵作为栓塞材料的PVE组。主要终点为FLR增长速率和二期手术切除率。结果各组的手术切除例数及二期手术切除率分别为:ALPPS组38例(99.4%),NBCA组32例(76.2%),明胶海绵组20例(60.6%),微球组10例(83.3%)。ALPPS组、NBCA组、微球组的FLR增长速率分别为15.1 mL/d,10.0 m L/d和8.5 m L/d,均高于明胶海绵组(3.7 mL/d)。结论采用NBCA及微球作为栓塞材料的PVE导致FLR增长速率低于ALPPS,两种栓塞材料的PVE二期手术切除率相当。使用NBCA作为栓塞材料的PVE其FLR增长速率高于微球,且这两种栓塞材料的栓塞效果均优于明胶海绵。

Objective To compare the effects of portal vein embolization(PVE)with different embolic materials and two-step hepatectomy combined with liver separation and portal vein ligation(ALPPS)on the growth rate of residual liver volume(FLR),and to compare the growth rate of FLR in each group,second-stage surgical resection rate,intraoperative data and postoperative complications.Methods A single-center,prospective,non-randomized controlled comparative study was used.From November 2014 to December 2019,A total of 126 patients with unresectable hepatocellular carcinoma(HCC)or intrahepatic cholangiocarcinoma(ICC)due to insufficient FLR in the Third Affiliated Hospital of Naval Military Medical University from November 2014 to December 2019 were analyzed.It is divided into 4 groups:ALPPS group and PVE groups which uses nbutyl cyanoacrylate(NBCA),microspheres,and gelatin sponge as embolic materials.The primary endpoints were the FLR growth rate and the second-stage surgical resection rate.Results The number of surgical resection cases and the second-stage surgical resection rate in each group were 38 cases(99.4%)in the ALPPS group,32 cases(76.2%)in the NBCA group,20 cases(60.6%)in the gelatin sponge group,and 10 cases in the microsphere group.(83.3%).The FLR growth rate of the ALPPS group,NBCA group,and microsphere group were 15.1 mL/d,10.0 mL/d and 8.5 mL/d,respectively,which were higher than those of the gelatin sponge group(3.7 m L/d).Conclusion PVE using NBCA and microspheres as embolization materials results in a lower FLR growth rate than ALPPS,but the second-stage surgical resection rate is equivalent.The FLR growth rate of PVE using NBCA as embolization material is higher than that of microspheres,and the embolization effect of these two embolization materials is better than that of gelatin sponge.