门静脉栓塞术在结直肠癌肝转移患者二期肝切除术中的疗效与安全性
Efficacy and safety of portal vein embolization for two-stage hepatectomy in patients with colorectal liver metastasis.
作者信息
Huang Steven Y, Aloia Thomas A, Shindoh Junichi, Ensor Joe, Shaw Colette M, Loyer Evelyne M, Vauthey Jean-Nicolas, Wallace Michael J
机构信息
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030.
出版信息
J Vasc Interv Radiol. 2014 Apr;25(4):608-17. doi: 10.1016/j.jvir.2013.10.028. Epub 2013 Dec 5.
PURPOSE
To examine the efficacy and safety of portal vein embolization (PVE) when used during two-stage hepatectomy for bilobar colorectal liver metastases (CLM).
MATERIALS AND METHODS
PVE was performed as an adjunct to two-stage hepatectomy in 56 patients with CLM. Absolute future liver remnant (FLR) volumes, standardized FLR ratios, degree of hypertrophy (DH), and complications were analyzed. Segment II and III volumes and DH were also measured separately. All volumetric measurements were compared with a cohort of 96 patients (n = 37 right portal vein embolization [RPVE], n = 59 right portal vein embolization extended to segment IV portal veins [RPVE+4]) in whom PVE was performed before single-stage hepatectomy.
RESULTS
For patients who completed RPVE during two-stage hepatectomy (n = 17 of 17), mean absolute FLR volume increased from 272.1 cm(3) to 427.0 cm(3) (P < .0001), mean standardized FLR ratio increased from 0.17 to 0.26 (P < .0001), and mean DH was 0.094. For patients who completed RPVE+4 during two-stage hepatectomy (n = 38 of 39), mean FLR volume increased from 288.7 cm(3) to 424.8 cm(3) (P < .0001), mean standardized FLR increased from 0.18 to 0.26 (P < .0001), and mean DH was 0.083. DH of the FLR was not significantly different between two-stage hepatectomy and single-stage hepatectomy. Complications after PVE occurred in five (8.9%) patients undergoing two-stage hepatectomy.
CONCLUSIONS
PVE effectively and safely induced a significant DH in the FLR during two-stage hepatectomy in patients with CLM.
目的
探讨门静脉栓塞术（PVE）用于双叶结直肠癌肝转移（CLM）患者二期肝切除时的有效性和安全性。
材料与方法
56例CLM患者接受了PVE作为二期肝切除的辅助治疗。分析了绝对未来肝残余（FLR）体积、标准化FLR比值、肥大程度（DH）及并发症情况。还分别测量了Ⅱ段和Ⅲ段的体积及DH。所有体积测量值均与96例在一期肝切除前行PVE的患者队列（n = 37例右门静脉栓塞[RPVE]，n = 59例右门静脉栓塞扩展至Ⅳ段门静脉[RPVE+4]）进行比较。
结果
在二期肝切除时完成RPVE的患者（17例中的17例），平均绝对FLR体积从272.1 cm³增加至427.0 cm³（P <.0001），平均标准化FLR比值从0.17增至0.26（P <.0001），平均DH为0.094。在二期肝切除时完成RPVE+4的患者（39例中的38例），平均FLR体积从288.7 cm³增加至424.8 cm³（P <.0001），平均标准化FLR从0.18增至0.26（P <.0001），平均DH为0.083。二期肝切除和一期肝切除之间FLR的DH无显著差异。二期肝切除的患者中有5例（8.9%）发生了PVE后并发症。
结论
PVE在CLM患者二期肝切除期间有效且安全地诱导了FLR的显著肥大。
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