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目的 探讨超声引导下经皮经肝细针穿刺术前选择性门静脉栓塞 (POSPVE)后对不宜手术切除的肝细胞性肝癌 (HCC)二期切除的可能性。 方法 32例不宜手术切除的HCC患者行超声引导下经皮经肝细针穿刺POSPVE ,观察手术成功率及术后不良反应、各肝叶体积及预计肝切除率的动态变化、二期手术切除率等指标。 结果 手术成功 30例 (93.8% ) ,右侧门静脉支栓塞后右肝体积逐步减少 ,左肝体积逐步增大 ,术前、术后 1w、2w、3w时的预计肝切除率分别为 6 6 .6 %、6 5 .5 %、6 2 .9%、6 0 6 %。术后 2 6例出现不同程度的肝区隐痛 (2 6例 )、低热 (19例 )、恶心呕吐 (7例 )。有程度不同的肝功能减退 ,AST由术前 (44 .6± 5 .3)IU/L ,至术后 1d (5 6 .2± 7.6 )IU/L ,术后 3d (5 1.4± 5 .5 )IU/L ;ALT由术前(5 8.4± 7.4 )IU/L ,至术后 1d (6 2 .8± 9.6 )IU/L ,术后 3d (6 0 .2± 8.5 )IU/L ;TBIL由术前 (14 .6± 5 .3) μmol/L至术后 1d (19.1± 8.6 ) μmol/L ,术后 3d (17.4± 7.7) μmol/L ;PT由术前 (82 .6± 6 .3) % ,至术后 1d (78.6±8.2 ) % ,术后 3d (75 .3± 6 .4 ) %。术后 2w - 4w ,14例 (43.8% )完成了肝癌二期肝切除手术。 结论 超声引导下经皮经肝细针穿刺POSPVE简便易行 ,可扩大肝癌肝切除手术
Objective To explore the possibility of secondary resection of hepatocellular carcinoma (HCC) that is unsuitable for surgical resection after ultrasound guided percutaneous transhepatic fine needle aspiration (POSPVE). Methods Thirty-two patients with HCC who were unfavorable for surgery underwent ultrasound-guided percutaneous fine needle puncture of POSPVE to observe the success rate of operation and postoperative adverse reactions, the dynamic changes of liver volume and hepatic resection rate, And other indicators. Results The operation was successful in 30 cases (93.8%). After right portal vein embolization, the right hepatic volume gradually decreased and the left hepatic volume gradually increased. The expected hepatectomy rates at preoperative, 1w, 2w and 3w postoperatively were 66. 6%, 65.5%, 62.9%, 60.6%. Postoperative 26 cases showed varying degrees of liver pain (26 cases), fever (19 cases), nausea and vomiting (7 cases). There were different degree of liver dysfunction, AST from preoperative (44.6 ± 5.3) IU / L to 1d (5.6 ± 7.6) IU / L, 3d (5 ± 1.4 ± 5) 5) IU / L; ALT from preoperative (5.4 ± 7.4) IU / L to 1d (6.2 ± 9.6) IU / L and postoperative 3d (6 ± 0.2 ± 8.5) IU / L ; TBIL decreased from (14.6 ± 5.3) μmol / L to (19.1 ± 8.6) μmol / L preoperatively and 3d (17.4 ± 7.7) μmol / ± 6 .3)%, 1d after operation (78.6 ± 8.2)%, 3d (75.3 ± 6.4%) after operation. Postoperative 2w - 4w, 14 cases (43.8%) completed the second liver cancer liver resection. Conclusion Ultrasound-guided percutaneous transhepatic needle puncture POSPVE is simple and easy to expand liver cancer surgery