CAJ | 학술논문

目的探讨经皮选择性门静脉栓塞(PVE)术治疗肝癌的临床价值及肝硬化对其疗效的影响.方法对13例无手术适应证的右肝肝癌患者,根据是否患有肝硬化,将患者分为无肝硬化组(n=7)和有肝硬化组(n=6).所有患者均先行肝动脉化疗栓塞术(TACE)治疗1～3次,体积不足者再行经皮经导管选择性门静脉右支栓塞术.PVE术前、术后CT测量左肝体积,体积足够大者行右半肝切除术.结果所有患者均成功行TACE治疗,11例行1次、1例行2次、1例行3次TACE治疗,均于末次TACE治疗结束后2～4周顺利实现门静脉右支栓塞,所有患者PVE后顺利实行右半肝切除术.PVE术前左肝体积为(457.0±121.0)cm3,术后4～6周为(633.6±120.2)cm3,比术前增加(44.4±39.7)％;术后4～6周较术前体积增大,差异有统计学意义(P =0.000).无肝硬化组PVE术前左肝体积(442.0±96.8)cm3,PVE术后4～6周为(652.3 ±115.8) cm3,比术前增加(54.5±50.7)％,有硬化组PVE术前左肝体积(474.5±152.4) cm3,PVE术后4～6周(611.7 ±132.3) cm3,比术前增加(32.7±19.9)％.两组术后4～6周较术前体积增大,差异均有统计学意义(P=0.011,P =0.003),而术后4～6周两组间左肝体积差异无统计学意义(P =0.295).所有患者PVE后肝功能损害轻,未出现严重并发症.结论联合应用TACE及PVE术治疗原发性肝癌可使残留肝叶代偿性增生,可增加手术切除率,肝硬化对PVE术后肝叶增生无明显影响.
목적 탐토경피선택성문정맥전새(PVE)술치료간암적림상개치급간경화대기료효적영향.방법 대13례무수술괄응증적우간간암환자,근거시부환유간경화,장환자분위무간경화조(n=7)화유간경화조(n=6).소유환자균선행간동맥화료전새술(TACE)치료1～3차,체적불족자재행경피경도관선택성문정맥우지전새술.PVE술전、술후CT측량좌간체적,체적족구대자행우반간절제술.결과 소유환자균성공행TACE치료,11례행1차、1례행2차、1례행3차TACE치료,균우말차TACE치료결속후2～4주순리실현문정맥우지전새,소유환자PVE후순리실행우반간절제술.PVE술전좌간체적위(457.0±121.0)cm3,술후4～6주위(633.6±120.2)cm3,비술전증가(44.4±39.7)％;술후4～6주교술전체적증대,차이유통계학의의(P =0.000).무간경화조PVE술전좌간체적(442.0±96.8)cm3,PVE술후4～6주위(652.3 ±115.8) cm3,비술전증가(54.5±50.7)％,유경화조PVE술전좌간체적(474.5±152.4) cm3,PVE술후4～6주(611.7 ±132.3) cm3,비술전증가(32.7±19.9)％.량조술후4～6주교술전체적증대,차이균유통계학의의(P=0.011,P =0.003),이술후4～6주량조간좌간체적차이무통계학의의(P =0.295).소유환자PVE후간공능손해경,미출현엄중병발증.결론 연합응용TACE급PVE술치료원발성간암가사잔류간협대상성증생,가증가수술절제솔,간경화대PVE술후간협증생무명현영향.
Objective To evaluate the clinical value of PVE (portal vein embolism) prior to surgery in primary liver cancer(PLC) patients and the effect of liver cirrhosis on liver lobe hyperplasia after PVE.Methods 13 patients with primary liver cancer non-suitable for curative hepatectomy underwent k sequential transcatheter arterial chemoembolization (TACE) (1-3 times) and percutaneous selective portal vein embolization (PVE) when the remnant liver volumes were predicted to be insufficient.All patients were divided into non-cirrhosis (n =7) and cirrhosis group (n =6).Left liver remnant volumes were assessed by computed tomography (CT) before and after PVE.Right liver resection was performed when the remnant liver volume was sufficient.Results All patients underwent TACE treatment was successful.The frequency of TACE was 1-3.PVE was all successfully performed at weeks 2-4 after final TACE,all PVE patients subsequently underwent hepatic lobectomy.Left liver volume increased from (457.0 ± 121.0) cm3 pre-PVE to (633.6 ± 120.2)cm3 post-PVE.Hepatic lobe volume increased (44.4 ±39.7)％.Statistical difference existed in left hepatic lobe volume before and weeks 4-6 after PVE (P =0.000).The mean volume of left liver,calculated before and 4-6 weeks after PVE,increased from (442.0 ±96.8) to (652.3 ± 115.8) cm3 in non-cirrhotic group and from (474.5 ± 152.4) to (611.7 ± 132.3) cm3 in cirrhotic group.Hepatic lobe volume increased (54.5 ±50.7)％ and (32.7 ± 19.9)％ respectively.Statistical differences were both detected in left hepatic lobe volume before and 4-6 weeks after PVE (P =0.011,P =0.003).However,no significant inter-group difference existed at Weeks 4-6 weeks (P =0.295).Liver function damage was minimal after PVE and no serious complications occurred.Conclusion Sequential transcatheter arterial chemoembolization,TACE and percutaneous selective PVE before surgery may cause ramnant liver compensatory hypertrophy and increase the resection rate of primary liver cancer.Liver cirrhosis has no significant effect on liver lobe hyperplasia after PVE.