术前选择性门静脉栓塞在肝癌二期切除中的应用

Role of preoperative selective portal vein embolization in two-stage hepatectomy for primary hepatocellular carcinoma

目的 探讨术前选择性门静脉栓塞 (POSPVE)后不能手术切除的原发性肝癌 (HCC)二期切除的可能性。方法 采用B超引导下经皮经肝细针门静脉分支穿刺栓塞法对 2 6例不能手术切除的HCC病人行POSPVE ,栓塞剂由无水乙醇、碘油按 1∶2比例配制 ,以 0 4ml/kg为标准 ,平均用量2 6 5ml。观察手术成功率及术后不良反应、肝功能改变、各肝叶体积及肝切除率的动态变化、二期手术切除率等指标。结果 POSPVE成功 2 4例 (92 3% ) ,右侧门静脉支栓塞的 2 1例栓塞后 ,右肝体积逐步减小 ,栓塞前、栓塞后 1,2 ,3周体积分别为 6 83 7,6 5 7 4 ,6 2 1 3,6 0 4 1cm3 ,左肝体积逐步增大 ,栓塞前、栓塞后 1,2 ,3周体积分别为 332 2 ,343 7,375 1,392 8cm3 。肝切除率逐步下降 ,栓塞前、栓塞后 1,2 ,3周分别为 6 6 3%、6 5 4 %、6 2 7%、5 9 2 %。POSPVE后出现不同程度的肝区隐痛、恶心呕吐、低热和以肝酶、胆红素升高为主的肝功能减退。POSPVE后 2～ 3周 ,12例 (4 6 2 % )完成了肝切除术。结论 POSPVE扩大肝癌肝切除手术的适应证 ,提高手术的安全性 ,具有确定的临床实用价值。

Objective To determine the possibility of two-stage hepatectomy for primary hepatocellular carcinoma (HCC) after preoperative selective portal vein embolization (POSPVE). Methods A total of 26 HCC patients were treated with percutaneous transhepatic POSPVE by fine needle under the guidance of ultrasonography. The embolizing material was composed of ethanol and idol oil at a ratio of 1/2, and 0.4 ml/kg was considered as the standard dosage. The average amount was 26.5 ml. The rate of success, adverse reactions, changes of hepatic function, hepatic lobe volume and rate of hepatectomy were determined. Results POSPVE was successfully performed in 24 patients. In those 21 whose right portal vein was embolized, the right liver volume decreased from 683.7 cm3 preoperatively to 657.4 cm3, 621.3 cm3 and 604.1 cm3 in 1, 2 and 3 weeks after the operation. Meanwhile, the left liver volume increased from 332.2 cm3 preoperatively to 343.7 cm3, 375.1 cm3 and 392.8 cm3 in 1, 2 and 3 weeks postoperatively. The rate of hepatectomy was eased from 66.3% preoperatively to 65.4%, 62.7% and 59.2% in 1, 2 and 3 weeks postoperatively. The adverse reactions included different degrees of pain of the liver area, nausea, vomiting, low fever and hepatic function decrease with elevation of hepatic enzyme and bilirubin. Two to 3 weeks later, hepatectomy was successfully performed in 12 patients (46.2%). Conclusions POSPVE increases the indications of hepatectomy for HCC and elevates the security of hepatectomy. Therefore, it has definite value of clinical practice.