摘要
目的评估门静脉右支栓塞诱导左肝叶代偿性增生临床应用的可行性、安全性、有效性。方法对36例不能手术切除、但门静脉内无瘤栓的晚期肝癌行门静脉右支栓塞。CT测量栓塞前后左侧肝叶的体积,并测量栓塞前后的门静脉压力,监测肝功能。结果所有患者均成功行门静脉右支栓塞,其中2例门静脉栓塞后顺利实行右肝切除术。栓塞术前左侧肝叶的体积为(459.3±92.5)cm3,术后2,4,8周其体积达(613.6±115.8),(665.1±109.7),(688.0±112.6)cm3,分别比术前增加33.6%,44.8%,49.8%;术前左侧肝叶占整个肝脏的体积百分比为(18.5±4.2)%,术后2,4,8周分别为(24.4±5.1)%,(26.0±5.3)%,(26.6±5.7)%。术后2周较术前体积增大差别有统计学意义(P<0.05),术后4周与2周间、术后8周与2周间、术后8周与术后4周间体积增大差别无统计学意义。栓塞前后门静脉压力分别为(17.6±3.1)cmH2O和(18.2±3.0)cmH2O,差别有统计学意义(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。结论门静脉右支栓塞诱导左肝叶代偿性增生的临床应用是可行的、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 percutaneous right portal vein embolization （PVE） inducing compensatory hypertrophy of the left liver. Methods PVE was performed in 36 patients with unresectable advanced liver cancers. Right portal veins were em- bolized with percutaneous transhepatic or percutaneous transplenic approach through the fluoroscopic guid- ance. Left hepatic lobe volume was measured with CT scans before and after PVE. Portal venous pressure and liver function were also measured before and after PVE. Results Right portal veins were embolized successfully in all patients. Right liver resection was performed in 2 patients. The left hepatic lobe volume was （459.3± 92.5） cm^3 before PVE, and（613.6± 115.8） cm^3, （665. 1 ± 109.7） cm^3, （688.0± 112.6）cm^3 , respectively 2 weeks, 4 weeks, and 8 weeks after PVE. Left hepatic lobe volume increased 33.6 %,44.8 %, and 49.8 %, respectively. The percentage of left hepatic lobe to the total hepatic volume was（18.5±4.2） %, （24.4±5.1）%,（26.0±5.3） %, and （26.64±5.7）% 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 （P〈0.05）. The portal venous pressure was （17.6±3.1） cm H2O and （18. 24± 3.0） cm H2O before and after PVE. There was statistical difference in portal venous pressure before and after PVE （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 PVE is clinically feasible and effective in inducing the compensatory hypertrophy of the remnant liver. It can increase the resection rate and safety of operation.
出处
《福建医科大学学报》
2008年第4期333-336,共4页
Journal of Fujian Medical University
关键词
肝肿瘤
栓塞
治疗性
门静脉
增生
liver neoplasm
enbolization,therapeutic
portal vein
hyperplasia
