Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma
Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma
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DOI：
10.1002/bjs.5341
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发表时间：
2006-09-01
影响因子：
9.6
通讯作者：
Vilgrain, V.
中科院分区：
文献类型：
--
作者：
Ogata, S.;Belghiti, J.;Vilgrain, V.
背景：选择性经动脉化疗栓塞（TACE）和门静脉栓塞（PVE）可以改善慢性肝病患者未来肝脏残余（FLR）的肥大率。本研究评价了这种联合手术的可行性和有效性。方法：1998年11月至2004年10月，对36例肝硬化合并肝细胞癌患者行PVE后右肝切除术。 18 名患者（TACE + PVE 组）在 PVE 之前 3-4 周额外接受 TACE，其余 18 名患者仅接受 PVE（PVE 组）。结果：所有患者的 PVE 耐受性良好。 TACE + PVE 组的 FLR 体积百分比平均增加显着高于 PVE 组（平均值（标准差）12(5)% vs 8(4)%；P = 0.022）。 TACE + PVT 组的 12 名患者和仅接受 PVE 的 5 名患者的肥厚率超过 10%（P = 0.044）。两组的手术时间、失血量、肝衰竭发生率和死亡率（每组两名患者）相似。 FLR 体积增加超过 10% 的 17 名患者均未死亡，而 FLR 体积增加较小的 19 名患者中有 4 人死亡。 TACE + PVF 组完全坏死的发生率显着较高（18 例中的 15 例 vs 18 例中的 1 例；P < 0.001），并且 5 年无病生存率较高（37% vs 19%；P = 0.041）。结论：术前序贯 TACE 和 PVE 增加了 FLR 肥大率，导致肿瘤完全坏死率较高，且手术时间较长。无复发生存期。
Background: Selective transarterial chemoembolization (TACE) and portal vein embolization (PVE) could improve the rate of hypertrophy of the future liver remnant (FLR) in patients with chronic liver disease. This study evaluated the feasibility and efficacy of this combined procedure.Methods: Between November 1998 and October 2004, 36 patients with cirrhosis and hepatocellular carcinoma underwent right hepatectomy after PVE. Additional TACE preceded PVE by 3-4 weeks in 18 patients (TACE + PVE group) and the remaining 18 patients had PVE alone (PVE group).Results: PVE was well tolerated in all patients. The mean increase in percentage FLR volume was significantly higher in the TACE + PVE group than in the PVE group (mean(s.d.) 12(5) versus 8(4) per cent; P = 0.022). The rate of hypertrophy was more than 10 per cent in 12 patients in the TACE + PVT group and in five who had PVE alone (P = 0.044). Duration of surgery, blood loss, incidence of liver failure and mortality (two patients in each group) were similar in the two groups. None of the 17 patients with an increase in FLR volume of more than 10 per cent died, whereas there were four deaths among 19 patients with a smaller increase. The incidence of complete turnout necrosis was significantly higher in the TACE + PVF group (15 of 18 versus one of 18; P < 0.001), with a higher 5-year disease-free survival rate (37 versus 19 per cent; P = 0.041).Conclusion: Sequential TACE and PVE before operation increases the rate of hypertrophy of the FLR and leads to a high rate of complete tumour necrosis associated with longer recurrence-free survival.