选择性门静脉栓塞术治疗原发性肝癌的研究
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摘要
背景：
原发性肝癌是一种世界性的常见的恶性肿瘤,尽管医疗技术迅猛发展,肝脏部分切除术仍是肝癌的唯一根治手段。选择性门静脉栓塞通过刺激肝脏增生增加肝脏切除术后的残肝体积,大大提高进展期肝癌的手术切除率,但对于其安全性、有效性及长期预后仍存在一定的争议。
目的：
本研究旨在通过对本中心接受门静脉栓塞与未行门静脉栓塞的肝癌患者的临床肝脏增生情况及肝脏切除术后一般情况的比较,探讨选择性门静脉栓塞在治疗原发性肝癌中的作用与价值。
方法：
采用肿瘤分期与病理类型配对方法选取2011年1月1日至2012年12月31日在我院行右半肝切除术的肝癌病人共48例,分为TACE+PVE+手术组、TACE+手术组、及单纯手术组。测定其术前AFP水平、HBsAg'隋况、肝功能情况以及凝血功能情况,术前CT扫描评估肿瘤分级,手术病理明确肿瘤病理类型及分化程度,并追踪术后并发症情况及长期生存情况；对行选择性门静脉栓塞治疗的病人,在选择性门静脉栓塞治疗前及栓塞后4周均行CT扫描测量左肝体积,并测定选择性门静脉栓塞前及栓塞后4周的肝功能情况、凝血功能及肿瘤分级。用SPSS检验组间有无显著性差异。
结果：
1)序贯行肝动脉插管化疗、选择性门静脉栓及肝切手术较肝动脉插管化疗后行肝切手术、以及单纯肝切手术而言,对患者术后的长期生存率并无显著影响,但可改善肿瘤过大、无法直接手术治疗的肝癌患者的预后；2)序贯行肝动脉插管化疗、选择性门静脉栓塞治疗对患者肝功能并无显著影响(包括谷丙转氨酶、凝血酶原时间、血清胆红素、白蛋白等)(P>0.05)；3)选择性门静脉栓塞对原发性肝癌的进展并无显著影响；4)患者肝硬化成堆对选择性门静脉栓塞治疗后残余肝脏的增生及手术时间的选择无显著影响(26.6±20.7%vs50.4±24.0%,P=0.116；37.8±10.4天vs43.5±8.6天,P=0.344)。
结论：
在肝动脉插管化疗基础上,行选择性门静脉栓塞治疗,再适时选择肝癌切术的治疗方案,是一种提高原发性肝癌根治性切除率的安全且有效的手段,并能在一定程度上改善原发性肝癌患者的预后。
Background:
Hepatocellular carcinoma (HCC) is one of the most prevalent cancer worldwide. The only curative treatment for malignant liver tumors is liver resection. Portal vein embolization(PVE) is worldwide accepted to increase the future remnant liver(FRL) to increase the resectability rate of patients with advanced liver carcinoma. However, the long-term outcome of the hypertrophy of the nonembolized future remnant liver after Portal vein embolization remains unknown.
Aims:
To evaluate the safety end efficacy of portal vein embolization prior to surgery in hepatocellular carcinoma (HCC) patients and to compare the clinical outcome of the patients undergoing portal vein embolization and those did not experience PVE.
Methods:
From Jan1st,2011to Dec20th,2012,48patients with HCC undergoing TACE+PVE+right hepatectomy, TACE+right hepatectomy and right hepatectomy alone were included.In each group, CT scan and liver volume were performed before and4weeks after PVE to assess degree of left lobe hypertrophy.
Results:
Baseline patients in each group were similar. Though, the PVE group had a larger tumor size (8.6±2.9cm, P=0.019), the overall survival among the three groups showed no significant difference. Before and after PVE, the liver enzymes and other parameters of liver functions were similar (P>0.05). There were no statistically significant differences of the tumor sizes and numbers before and after PVE. The mean increase in percentage FLR volume between the group of patients with liver cirrhosis and not suggest no marked difference (26.6±20.7%vs50.4±24.0%, P=0.116).
Conclusions:
Sequential TACE and PVE before surgery is a safe and effective way to increase the liver volume of FLR after right hepatectomy, and maybe leads to better survival in patients with advanced HCC.
原发性肝癌是一种世界性的常见的恶性肿瘤,尽管医疗技术迅猛发展,肝脏部分切除术仍是肝癌的唯一根治手段。选择性门静脉栓塞通过刺激肝脏增生增加肝脏切除术后的残肝体积,大大提高进展期肝癌的手术切除率,但对于其安全性、有效性及长期预后仍存在一定的争议。
目的：
本研究旨在通过对本中心接受门静脉栓塞与未行门静脉栓塞的肝癌患者的临床肝脏增生情况及肝脏切除术后一般情况的比较,探讨选择性门静脉栓塞在治疗原发性肝癌中的作用与价值。
方法：
采用肿瘤分期与病理类型配对方法选取2011年1月1日至2012年12月31日在我院行右半肝切除术的肝癌病人共48例,分为TACE+PVE+手术组、TACE+手术组、及单纯手术组。测定其术前AFP水平、HBsAg'隋况、肝功能情况以及凝血功能情况,术前CT扫描评估肿瘤分级,手术病理明确肿瘤病理类型及分化程度,并追踪术后并发症情况及长期生存情况；对行选择性门静脉栓塞治疗的病人,在选择性门静脉栓塞治疗前及栓塞后4周均行CT扫描测量左肝体积,并测定选择性门静脉栓塞前及栓塞后4周的肝功能情况、凝血功能及肿瘤分级。用SPSS检验组间有无显著性差异。
结果：
1)序贯行肝动脉插管化疗、选择性门静脉栓及肝切手术较肝动脉插管化疗后行肝切手术、以及单纯肝切手术而言,对患者术后的长期生存率并无显著影响,但可改善肿瘤过大、无法直接手术治疗的肝癌患者的预后；2)序贯行肝动脉插管化疗、选择性门静脉栓塞治疗对患者肝功能并无显著影响(包括谷丙转氨酶、凝血酶原时间、血清胆红素、白蛋白等)(P>0.05)；3)选择性门静脉栓塞对原发性肝癌的进展并无显著影响；4)患者肝硬化成堆对选择性门静脉栓塞治疗后残余肝脏的增生及手术时间的选择无显著影响(26.6±20.7%vs50.4±24.0%,P=0.116；37.8±10.4天vs43.5±8.6天,P=0.344)。
结论：
在肝动脉插管化疗基础上,行选择性门静脉栓塞治疗,再适时选择肝癌切术的治疗方案,是一种提高原发性肝癌根治性切除率的安全且有效的手段,并能在一定程度上改善原发性肝癌患者的预后。
Background:
Hepatocellular carcinoma (HCC) is one of the most prevalent cancer worldwide. The only curative treatment for malignant liver tumors is liver resection. Portal vein embolization(PVE) is worldwide accepted to increase the future remnant liver(FRL) to increase the resectability rate of patients with advanced liver carcinoma. However, the long-term outcome of the hypertrophy of the nonembolized future remnant liver after Portal vein embolization remains unknown.
Aims:
To evaluate the safety end efficacy of portal vein embolization prior to surgery in hepatocellular carcinoma (HCC) patients and to compare the clinical outcome of the patients undergoing portal vein embolization and those did not experience PVE.
Methods:
From Jan1st,2011to Dec20th,2012,48patients with HCC undergoing TACE+PVE+right hepatectomy, TACE+right hepatectomy and right hepatectomy alone were included.In each group, CT scan and liver volume were performed before and4weeks after PVE to assess degree of left lobe hypertrophy.
Results:
Baseline patients in each group were similar. Though, the PVE group had a larger tumor size (8.6±2.9cm, P=0.019), the overall survival among the three groups showed no significant difference. Before and after PVE, the liver enzymes and other parameters of liver functions were similar (P>0.05). There were no statistically significant differences of the tumor sizes and numbers before and after PVE. The mean increase in percentage FLR volume between the group of patients with liver cirrhosis and not suggest no marked difference (26.6±20.7%vs50.4±24.0%, P=0.116).
Conclusions:
Sequential TACE and PVE before surgery is a safe and effective way to increase the liver volume of FLR after right hepatectomy, and maybe leads to better survival in patients with advanced HCC.
引文
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[2]Llovet JM. Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma[J]. New England Journal of Medicine.2008;359(4):378-390.
[3]Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy:a model to predict long-term survival [J]. Annals of surgery.2004;240(4):644.
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