中国实用外科杂志

中国实用外科杂志

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术前门静脉栓塞在Ⅳ型肝门胆管癌的应用价值探讨

戴朝六a，龚    正a，贾昌俊a，徐    锋a，彭松林a，赵    闯a，温    锋b，卢再鸣b   

  1. 中国医科大学附属盛京医院a.肝胆脾外科 b.放射线科，辽宁沈阳110004
  • 发布日期:2012-10-19

  • Published:2012-10-19

摘要：

目的    探讨术前门静脉栓塞（portal vein embolization，PVE）在Ⅳ型肝门胆管癌中的应用价值。方法    对2010年12月至2011年2月中国医科大学附属盛京医院肝胆脾外科术前行PVE的2例Ⅳ型肝门胆管癌进行分析。结果    2例均行经皮经肝胆道引流（percutaneous transhepatic biliary drainage，PTBD）解除梗阻性黄疸，PVE诱导剩余肝体积代偿增生后，未来剩余肝（future liver remnant，FLR ）与全肝体积（total liver volume，TLV）之比分别为49.7%、43.7%，较PVE前分别增加7.9%，5.4%。2例行右半肝及尾状叶切除、肝门胆管癌根治术，手术顺利，术后恢复良好，至今分别无瘤生存18、19个月。 结论    PVE能够安全有效增加FLR，从而增加手术安全性，降低术后肝衰竭的发生率。

关键词: 门静脉栓塞, 肝门胆管癌, 半肝切除术

Abstract:

Application value of preoperative portal vein embolization for type Ⅳ hilar cholangiocarcinoma        DAI Chao-liu*，GONG Zheng，JIA Chang-jun， et al.  *Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital of China Medical University，Shenyang 110004，China
Corresponding  author：DAI Chao-liu，E-mail：278170678@qq.com
Abstract    Objective    To explore the application value of preoperative portal vein embolization (PVE) for type Ⅳ hilar cholangiocarcinoma. Methods    The data of 2 cases of type Ⅳ hilar cholangiocarcinoma performed preoperative PVE between December 2010 and February 2011 in Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital of China Medical University were analyzed. Results    Two cases were performed percutaneous transhepatic biliary drainage (PTBD) to release the obstructive jaundice. After PVE was performed to induce liver remnant compensatory hyperplasia, future liver remnant/total liver volume (FLR/TLV) was 49.7%, 43.7%, and increased 7.9%, 5.4%, respectively. Then right liver and caudate lobe resection, hilar cholangiocarcinoma radical resection were performed. Patients got good recovery with disease-free survival 18, 19 months. Conclusion    PVE is considered safe and effective to increase FLR, increase the safety of the operation and reduce the incidence of postoperative liver failure.

Key words: portal vein embolization, hilar cholangiocarcinoma, hemihepatectomy