末梢门静脉栓塞技术在余肝体积不足肝细胞癌中的应用价值

The clinical value of terminal branches portal vein embolization for hepatocellular carcinoma with insufficient future liver remnant

目的探讨末梢门静脉栓塞技术(TBPVE)在余肝体积(FLR)不足肝细胞癌中的应用价值。方法回顾性分析2016年12月至2021年5月于中国3家医院接受TBPVE治疗的150例肝细胞癌患者的病例资料。男性89例,女性61例,平均年龄51.9岁(范围:18~79岁)。HBV阳性101例,其中合并门静脉高压症27例。按照是否合并乙肝、是否行经导管动脉化疗栓塞(TACE)进行分层分析。统计FLR增生情况、接受手术治疗患者的预后;并分析不手术的患者采用TBPVE联合TACE的治疗效果。符合正态分布的计量资料的比较采用独立样本t检验;采用Kaplan-Meier生存曲线进行生存分析。结果TBPVE后第7天和第14天FLR平均增生率分别为56.2%和57.8%。合并乙肝组患者和无乙肝组患者TBPVE后第7天的FLR增生率分别为(55.0±27.3)%和(57.8±20.9)%,第14天的分别为(57.3±24.6)%和(58.3±23.7)%,差异均无统计学意义(t=0.885、0.801,P=0.373、0.447)。联合TACE组和未联合TACE组患者TBPVE后第7天的FLR增生率分别为(62.3±26.3)%和(48.8±20.6)%,第14天的分别为(64.4±25.0)%和(55.2±23.1)%,差异均无统计学意义(t=1.788、1.097,P=0.077、0.257)。53例患者实施后期手术,术后并发症发生率为20.8%(11/53),围手术期病死率为1.9%(1/53),术后1年和3年的总体生存率分别为87.5%和64.5%,无病生存率分别为64.7%和40.6%,其中合并乙肝组和无乙肝组患者的总体生存率和无病生存率的差异均无统计学意义(P值均>0.05);而联合TACE治疗组和未行TACE治疗组3年总体生存率、1年和3年的无病生存率的差异均有统计学意义(P值均<0.05)。97例TBPVE联合TACE治疗后未进行手术的患者的1年和3年总体生存率分别为80.1%和53.7%。结论TBPVE可以安全有效地在短期内促进FLR增生达到手术要求;同时联合TACE治疗可以进一步改善手术患者或无法手术患者的预后。

Objectives To examine the efficacy of terminal branches portal vein embolization(TBPVE)for the increment of FLR in hepatocellular carcinoma(HCC)patients and to introduce its clinical value with transcatheter chemoembolization(TACE)in the treatment of HCC patients without surgery.Methods One hundred and fifty HCC patients from three clinical centers of china underwent TBPVE technique from December 2016 to May 2021,including 89 males and 61 females.The average age was 51.9 years(range:18 to 79 years).One hundred and one patients were diagnosed with a background of HBV infection,including 27 patients with portal venous hypertension.TACE was performed simultaneously with TBPVE in 102 patients.Fifty-three patients underwent hepatectomy,who were subdivided into HBV positive and HBV negative groups,with TACE and without TACE groups to analyze the increment of future liver remnant(FLR),complications and survival data.These data were also analyzed in other 97 patients without hepatectomy.Results All the patients reached adequate FLR successfully in 14 days after TBPVE including patients with portal venous hypertension.The average increment rates of FLR was 56.2%in 7 days and 57.8%in 14 days after TBPVE.There was no significant difference neither between HBV positive and HBV negative groups(7 days:(55.0±27.3)%vs.(57.8±20.9)%,t=0.885,P=0.373;14 days:(57.3±24.6)%vs.(58.3±23.7)%;t=0.801,P=0.447),or between with TACE and without TACE groups(7 days:(62.3±26.3)%vs.(48.8±20.6)%;t=1.788,P=0.077;14 days:(64.4±25.0)%vs.(55.2±23.1)%;t=1.097,P=0.257).The morbidity and mortality rates were 20.8%and 1.9%in patients with hepatectomy.The 1-,3-year overall survival(OS)and disease-free(DFS)rates were 87.5%,64.5%and 64.7%,40.6%for patients underwent surgery.There was no significant difference of 1-,3-year OS and DFS between HBV positive and negative groups,but there were different between TACE and without TACE groups.The 1-,3-year OS for patients underwent TBPVE and TACE but without surgery were 80.1%,53.7%.Conclusion TBPVE is a good alternative technique for modulation of FLR for staged hepatectomy even in HBV positive HCC patients and can be applied with TACE procedure simultaneously as an option treatment for patients with no intend to surgery.