摘要
目的探讨经导管门静脉栓塞(PVE)诱导肝叶代偿性增生临床应用的可行性、安全性、有效性。方法对28例手术不能切除,但门静脉内无瘤栓的晚期肝癌患者,经导管行门静脉右支栓塞。PVE术前、后用CT测量左侧肝叶的体积,并测量栓塞前后的门静脉压力,监测肝功能和凝血功能。结果所有患者均成功行门静脉右支栓塞,其中1例PVE后顺利实行右肝切除术。PVE术前左侧肝叶的体积为(461.5±108.2)cm3,术后2、4、8周分别为(608.5±135.7)cm3、(660.2±133.8)cm3、(678.0±132.7)cm3,分别比术前增加(33.5±22.1)%、(45.4±23.8)%、(49.5±24.0)%;术前左侧肝叶占整个肝脏的体积百分比为(18.4±5.1)%,术后2、4、8周分别为(24.2±5.9)%、(26.3±5.8)%、(27.0±6.1)%。术后2周较术前体积增大差异有统计学意义(F=37.810,P<0.05),术后4周与术后2周间、术后8周与术后2周间、术后8周与术后4周间体积增大差异无统计学意义(P=0.206、0.091、0.085,P值均>0.05)。栓塞前门静脉压力为(17.8±2.9)cmH2O(1cmH2O=0.098kPa),PVE后为(18.3±2.9)cmH2O,栓塞前后差异有统计学意义(t=-14.810,P<0.05),但均在正常值范围内,未出现门静脉高压,肝功能损害轻,无并发症出现。结论经导管门静脉栓塞诱导肝叶代偿性增生在临床上的应用是可行的、安全的、有效的,可增加手术切除率,提高手术切除的安全性。
Objective To evaluate the clinical feasibility, safety, and effectiveness of transcatheter portal vein embelization （PVE） inducing compensatory hypertrophy of the remnant liver. Methods PVE was performed in 28 patients with unresectable advanced hepatocellular carcinoma. Right portal vein were embolized with percutaneous transhepatic or percutaneous transplenic approach through the fluoroscopic guidance. Left hepatic lobe volume was measured with CT scans before and after PVE. Portal venous pressure, liver function, and coagulation function were also measured before and after PVE. Results Right portal vein was embolized successfully in all patients. Right liver resection was performed in 1 patient. The left hepatic lobe volume was （461.5 ± 108.2） cm^3 before PVE, and （608.5 ± 135.7） cm^3, （660.2 ± 133.8） cm^3, and （678.0 ± 132.7） cm^3, respectively 2 weeks, 4 weeks, and 8 weeks after PVE. Left hepatic lobe volume increased （33. 5 ±22. 1）%, （45.4 ±23.8）%, and （49. 5 ±24.0）%, respectively. The percentage of left hepatic lobe to the total hepatic volume were （ 18.4 ± 5. 1 ） %, （ 24. 2 ± 5.9 ） %, （ 26. 3 ± 5. 8 ） %, and （27. 0 ± 6. 1 ） % before and 2 weeks, 4 weeks, and 8 weeks after PVE, respectively. There was statistical difference in left hepatic lobe volume before and 2 weeks after PVE （F = 37. 810,P 〈 0. 05）. No significant difference was detected 4 weeks and 2 weeks, 8 weeks and 2 weeks, 8 weeks and 4 weeks after PVE （ P = 0. 206,0. 091,0. 085 ）. The portal venous pressure was （ 17.8 ± 2. 9 ） cm H2O and （18.3 ±2.9） cm H2O before and after PVE. There was statistical difference in portal venous pressure before and after PVE （ t = - 14. 810, P 〈 0. 05 ） , but the value was normal. No patient had portal vein hypertension after PVE. Liver function damage after PVE was minimal. No patient had complication after PVE. Conclusion Transcatheter PVE is clinically feasible, safe and effective in inducing the compensatory hypertrophy of the remnant liver. It can increase the resection rate and safety of operation.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2006年第2期186-190,共5页
Chinese Journal of Radiology
基金
福建省卫生厅青年科研课题资助项目(2004-1-5)
关键词
栓塞
治疗性
门静脉
增生
评价研究
Embolization, therapeutic
Portal vein
Hyperplasia
Evaluation studies
