论文部分内容阅读
目的探讨肝门部胆管癌扩大肝切除术前使用经皮经肝钢圈选择性门静脉栓塞术(PVE)的应用和疗效。方法 2007年4月至2009年1月收治肝门部胆管癌28例,分为两组,将预保留肝占全肝体积<50%、接受PVE者设为PVE组12例,其中10例最终接受联合扩大肝切除者设为PVE肝切除组;同期未行PVE而接受扩大肝切除术者为非PVE切除术组(16例)。PVE均为伴有梗阻性黄疸的Ⅵ型肝门部胆管癌,11例PVE前行预保留肝选择性胆管引流,PVE前血清胆红素(TB)为(98.0±60.8)(12.4～167.9)μmol/L。PVE采用经皮经肝、同侧或对侧门静脉穿刺,放置多枚弹簧圈栓塞门静脉分支。记录PVE前后肝脏血流动力学、体积、功能等方面的变化,比较PVE肝切除组与非PVE肝切除组的术后病死率和并发症发生率。结果 12例PVE均获得成功,10例PVE后顺利施行扩大肝切除术,1例(1/12)因发现远处转移未行手术,另1例(1/12)因PVE后预保留肝叶增生不全未行手术。栓塞术后2周预保留肝叶体积增大差别有统计学意义(P<0.05),未出现严重门静脉高压、肝功能损害等严重并发症。结论 PVE在肝门部胆管癌扩大肝切除术前的临床应用可行、有效和安全,能有效的诱导未栓塞肝叶的增生肥大,提高肿瘤的切除率,增加手术切除的安全性。
Objective To investigate the application and curative effect of selective portal vein embolization (PVE) using percutaneous transhepatic ring before hepatectomy for hilar cholangiocarcinoma. Methods From April 2007 to January 2009, 28 patients with hilar cholangiocarcinoma were divided into two groups. The pre-preserved liver accounted for less than 50% of the total liver volume and the PVE group received 12 patients. Of these, 10 The patients undergoing combined hepatectomy with hepatectomy were enrolled in the PVE hepatectomy group. In the same period, patients who underwent extended hepatectomy without PVE were non-PVE patients (n = 16). PVE were all type Ⅵ hilar cholangiocarcinoma with obstructive jaundice. Eleven patients with PVE had pre-preserved hepatic selective biliary drainage. The level of serum bilirubin (TB) before PVE was (98.0 ± 60.8) (12.4-167.9) μmol / L. PVE percutaneous transhepatic, ipsilateral or contralateral portal vein puncture, placing multiple coil embolization of the portal vein branch. The changes of hepatic hemodynamics, volume and function were recorded before and after PVE. The postoperative mortality and complications of PVE liver resection group and non-PVE liver resection group were compared. Results PVE was successful in all 12 cases. Enlarged hepatectomy was successfully performed in 10 cases after PVE. One case (1/12) was not operated because of distant metastasis. Another case (1/12) Hyperplasia without surgery. Two weeks after embolization, the volume of pre-preserved hepatic lobe increased significantly (P <0.05), and no serious complications such as severe portal hypertension and hepatic dysfunction occurred. Conclusions The clinical application of PVE in hepatic hilar cholangiocarcinoma before hepatectomy is feasible, effective and safe. It can effectively induce hyperplasia and hypertrophy of non-embolized hepatic lobe, increase tumor resection rate and increase the safety of surgical resection.