Peng S Y, Huang C Y, Wang X A, Wang Y F, Zhang Y Y, Li J T, Xu B, Liang X, Wang J W, Hong D F, Cai X J
Department of Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.
Zhonghua Wai Ke Za Zhi. 2017 Sep 1;55(9):655-660. doi: 10.3760/cma.j.issn.0529-5815.2017.09.004.
To analyze the efficacy of branches portal vein embolization (TBPVE) combined with transcatheter arterial chemoembolization (TACE) on liver neoplasms. From August 2016 to May 2017, there were 13 patients including 11 males and 2 females with primary hepatocellular carcinoma who underwent TBPVE+ TACE , among whom there were 11 cases with a history of HBV infection.Average age of the 13 patients was (60.8±6.2)years. The live function of all patients were Child-Pugh A classification.The CT or MRI images of each patient was reconstructed and the standard liver volume(SLV) before TBPVE+ TACE was (1 181.2±49.3)ml, estimated future liver remnant(FLR) was (326.1±72.1)ml and FLR/SLV was (27.6±6.0)%.The puncture site for TBPVE was determined by the three-dimensional reconstruction of portal vein.CT scan or MRI, AFP and liver function test were repeated after one and two weeks after TBPVE+ TACE.FLR and FLR/SLV were calculated respectively.Hepatectomy would be performed if the patients agreed.The postoperative complications were analyzed. On the 7day after TBPVE+ TACE, the FLR/SLV was(42.6±8.0)% and the FLR increasement was(56.0±24.6)%.The level of AFP decreased from(87.9±81.8)μg/L to (29.7±20.9)μg/L.On the 14day after TBPVE+ TACE, the FLR/SLV was(45.8±6.2)% and the FLR increasement was(71.8±29.0)%.Four patients underwent surgery which including 2 right hepatectomies and 2 right trisegmentectomies in 2 weeks after TBPVE+ TACE.Nine patients were performed with targeting intratumoral lactic acidosis TACE (TILA-TACE). No severe complication occurred in all patients. TBPVE could induce a rapid growth of the liver remnant but still with the concern of inducing the growth of neoplasms at the same time.To combine TACE in TBPVE therapy not also can the growth of neoplasms be prevented but also inducing its shrinking.This method might be a new mode for the treatment of hepatocellular carcinoma.
分析门静脉分支栓塞术（TBPVE）联合经动脉化疗栓塞术（TACE）治疗肝脏肿瘤的疗效。2016年8月至2017年5月，13例原发性肝细胞癌患者（男11例，女2例）接受了TBPVE + TACE治疗，其中11例有乙肝病毒感染史。13例患者的平均年龄为（60.8±6.2）岁。所有患者肝功能均为Child-Pugh A级。对每位患者的CT或MRI图像进行重建，TBPVE + TACE术前标准肝体积（SLV）为（1181.2±49.3）ml，预计未来肝残余量（FLR）为（326.1±72.1）ml，FLR/SLV为（27.6±6.0）%。TBPVE的穿刺部位通过门静脉三维重建确定。TBPVE + TACE术后1周和2周分别复查CT扫描或MRI、甲胎蛋白（AFP）及肝功能。分别计算FLR和FLR/SLV。若患者同意则行肝切除术。分析术后并发症。TBPVE + TACE术后7天，FLR/SLV为（42.6±8.0）%，FLR增加量为（56.0±24.6）%。AFP水平从（87.9±81.8）μg/L降至（29.7±20.9）μg/L。TBPVE + TACE术后14天，FLR/SLV为（45.8±6.2）%，FLR增加量为（71.8±29.0）%。4例患者在TBPVE + TACE术后2周内接受了手术，其中2例行右半肝切除术，2例行右三叶切除术。9例患者接受了靶向肿瘤内乳酸酸中毒TACE（TILA-TACE）治疗。所有患者均未发生严重并发症。TBPVE可促使肝残余快速增长，但同时仍存在诱发肿瘤生长的担忧。TBPVE治疗中联合TACE不仅可预防肿瘤生长，还可促使其缩小。该方法可能是治疗肝细胞癌的一种新模式。
