CAJ | 학술논문

目的探讨无法常规根治性切除的原发性及转移性肝癌的外科治疗方法并观察其疗效.方法对1例乙状结肠癌并同时左、右肝多发转移患者一期行根治性原发肿瘤切除及肝左外叶切除,术后行右肝门静脉栓塞化疗(PVCE),5周后行右半肝切除术.对另1例巨大原发性肝癌患者,先行肝动脉栓塞化疗,1周后行PVCE,PVCE后4周行肝右三叶切除术.结果 PVCE术前患者肝脏体积分别是左肝435.1 cm3,右肝1380.0 cm3.肝左外叶151.5 cm3,右三叶1685.4 cm3;PVCE术后4周,右肝显著缩小,左肝代偿性增大.患者肝脏体积分别是左肝624.4 cm3,右肝740.2 cm3.左外叶560.2 cm3,右三叶1228.1 cm3.剩余肝脏的体积占估计全肝体积的比率从PVCE术前的25.6%、13.6%分别升至PVCE 4周的50.0%、43.1%.肝切除术后肝功能恢复良好,血清癌胚抗原及甲胎蛋白水平恢复正常.2例患者术后分别随访18、8个月,无复发.结论 PVCE可防止肝大部切除术后的肝功能衰竭,扩大肝切除术的适应证.
목적 탐토무법상규근치성절제적원발성급전이성간암적외과치료방법병관찰기료효.방법 대1례을상결장암병동시좌、우간다발전이환자일기행근치성원발종류절제급간좌외협절제,술후행우간문정맥전새화료(PVCE),5주후행우반간절제술.대령1례거대원발성간암환자,선행간동맥전새화료,1주후행PVCE,PVCE후4주행간우삼협절제술.결과 PVCE술전환자간장체적분별시좌간435.1 cm3,우간1380.0 cm3.간좌외협151.5 cm3,우삼협1685.4 cm3;PVCE술후4주,우간현저축소,좌간대상성증대.환자간장체적분별시좌간624.4 cm3,우간740.2 cm3.좌외협560.2 cm3,우삼협1228.1 cm3.잉여간장적체적점고계전간체적적비솔종PVCE술전적25.6%、13.6%분별승지PVCE 4주적50.0%、43.1%.간절제술후간공능회복량호,혈청암배항원급갑태단백수평회복정상.2례환자술후분별수방18、8개월,무복발.결론 PVCE가방지간대부절제술후적간공능쇠갈,확대간절제술적괄응증.
Objective To investigate the surgical treatment of initially unresectable primary and secondary hepatic tumors. Methods For the patients with multiple and bilobar colonic hepatic metastases,a first-stage hepatectomy consisted in a radical resection of sigmoid colonic carcinoma and left lateral hepatic segment. Subsequently, under the guidance of ultrasonography and radiography, a right portal vein chemoembolization (PVCE) was performed via a percutaneous approach through left portal branch to induce the atrophy of right hemiliver and hypertrophy of left hemiliver. At Week 5 post-PVCE, a second-stage hepatectomy was planned to resect the right hemiliver. For patients with huge hepatocellular carcinoma (HCC), transcatheter arterial chemoembolization (TACE) were performed and it was followed by PVCE 1 week later. At Week 4 post-PVCE, a right trisegmentectomy was attempted to resect the right liver tumor.The volume of liver was evaluated with three-dimensional CT scan at Weeks 2 and 4 weeks post-PVCE.Results At Week 4 post-PVCE, the atrophy of right lobe was induced and the left lobe underwent compensatory hypertrophy. The remnant volumes of right lobe and right trisegment for HCC decreased from 1380. 0 cm3, 1685.4 cm3 at pre-PVCE to 740. 2 cm3 , 1228. 1 cm3 at Post-PVCE. The values increased from pre-PVCE 435.1 cm3, 151.5 cm3 to Post-PVCE 624.4 cm3, 560. 2 cm3 for left hepatic lobe remnant of colonic liver metastases and left lateral segment for HCC. The ratios of liver remnant to estimated total liver volume increased from 25.6%, 13.6% at pre-PVCE to 50.0%, 43. 1% post-PVCE respectively. The postoperative course was uneventful. The liver function, serum CEA and AFP decreased to the normal levels. Two patients were followed up for 18 and 8 months respectively. There was no tumor recurrence.Conclusion PVCE prevents the hepatic function failure after a major hepatectomy. And it may benefit more patients with previously unresectable liver tumors.