门静脉栓塞术在二期精准肝切除中的应用

doi:10.16139/j.1007-9610.2018.03.013

外科理论与实践 ›› 2018, Vol. 23 ›› Issue (03): 247-251.doi: 10.16139/j.1007-9610.2018.03.013

门静脉栓塞术在二期精准肝切除中的应用

金圣杰, 范逸群, 柏斗胜, 蒋国庆, 钱建军, 姚捷, 王小东, 高志慧, 张弛

扬州大学临床医学院肝胆胰外科普通外科研究所, 江苏扬州 225001

收稿日期:2018-01-31 发布日期:2020-07-25
通讯作者: 柏斗胜,E-mail: bdsno1@sina.com
基金资助:
江苏省卫生科研项目（H201661）

Experience of portal vein embolization for two-stage precise hepatectomy

JIN Shengjie, FAN Yiqun, BAI Dousheng, JIANG Guoqing, QIAN Jianjun, YAO Jie, WANG Xiaodong, GAO Zhihui, ZHANG Chi

Department of Hepatobiliary Pancreatic Surgery, Clinical Medical College of Yangzhou University, Institute of General Surgery, Jiangsu Yangzhou 225001, China

Received:2018-01-31 Published:2020-07-25

摘要/Abstract

摘要： 目的: 探讨门静脉栓塞术在二期精准肝切除的应用。方法: 分析7例在超声扫描及X线数字减影血管造影引导下,经皮经肝穿刺门静脉栓塞术后,行二期精准肝切除术的肝癌病人临床资料。分成肝硬化组3例和无肝硬化组4例,分别检测门静脉栓塞术前和术后肝功能指标及肝体积变化,总结二期手术切除。结果: 7例病人均成功实施经皮经肝穿刺门静脉栓塞术,其中6例病人达到肝脏体积代偿增大的预期效果,顺利完成二期精准肝切除术。1例结肠直肠癌肝转移病人在门静脉栓塞8周后,未栓塞肝脏代偿性增大体积未达到精准肝切除的条件,转外院顺利行拯救性联合肝脏离断和门静脉结扎的二步肝切除术。两组经皮经肝穿刺门静脉栓塞术后1 d,肝功能指标较术前升高（P<0.05）,予护肝治疗3~7 d后降至术前水平。未发生严重并发症。结论: 门静脉栓塞技术成功率高、安全可行。剩余肝脏代偿性增大明显,可显著提高二期精准肝切除手术率。

关键词: 门静脉栓塞术, 精准肝切除术, 肝脏肿瘤, 剩余肝脏体积

Abstract: Objective: To discuss the application of portal vein embolization in two-stage precise hepatectomy. Methods: Clinical data of 7 patients who underwent two-stage precise hepatectomy after percutaneous transhepatic portal vein embolization guided by ultrasound and digital subtraction angiography were analyzed in this study. There were 3 cases in liver cirrhosis group and 4 cases in without liver cirrhosis group. Liver function and liver volume were detected in each group before and after portal vein embolization, and the effect of two-stage surgical resection was examined. Results: Percutaneous transhepatic portal vein embolization was successfully performed in all 7 patients. Future liver remnant increased and hepatic hypertrophy was found in 6 patients who completed two-stage precise hepatectomy afterward. Non-embolized liver hypertrophy was not enough to the conditions for two-stage hepatectomy after 8 weeks in the other patient of colorectal cancer with liver metastases. The patient underwent the therapy of associating liver partition and portal vein ligation for staged hepatectomy in other hospital. In both groups liver function was abnormal at the first day after the percutaneous transhepatic portal vein embolization (P<0.05) and recovered to normal 3-7 days later. No severe complication was found in this study. Conclusions: Portal vein embolization is safe and feasible, and increases the volume of future liver remnant significantly. It can provide the opportunity of two-stage precise hepatectomy.

Key words: Portal vein embolization, Precise hepatectomy, Liver neoplasms, Future liver remnant

中图分类号:

R735.7

金圣杰, 范逸群, 柏斗胜, 蒋国庆, 钱建军, 姚捷, 王小东, 高志慧, 张弛. 门静脉栓塞术在二期精准肝切除中的应用[J]. 外科理论与实践, 2018, 23(03): 247-251.

JIN Shengjie, FAN Yiqun, BAI Dousheng, JIANG Guoqing, QIAN Jianjun, YAO Jie, WANG Xiaodong, GAO Zhihui, ZHANG Chi. Experience of portal vein embolization for two-stage precise hepatectomy[J]. Journal of Surgery Concepts & Practice, 2018, 23(03): 247-251.

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门静脉栓塞术在二期精准肝切除中的应用

Experience of portal vein embolization for two-stage precise hepatectomy

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