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目的探讨未来残余肝较小的肝门部胆管癌病人行门静脉栓塞是否安全有效。方法对2007年1月至2009年3月第二军医大学附属东方肝胆外科医院拟行大部肝切除、未来残余肝/全肝体积(FLR/TLV)比<50%的16例接受钢圈门静脉栓塞(portal vein embolization,PVE)的临床资料进行分析。结果术前16例(PVE组)因肝功能损害、FLR/TLV<50%者行PVE治疗,33例(非PVE组)FLR/TLV>50%者行肿瘤联合肝切除。PVE后3例出现并发症,原因为胆漏和钢圈移位,但未推迟肝切除术日期。16例PVE中1例合并肝硬化出现非栓塞肝叶增生不全而未能接受外科治疗,2例术中发现肿瘤进展、腹膜播散未能接受肝切除术,余13例(81.3%)行联合肝切除的肿瘤切除术。PVE组和非PVE组的手术并发症发生率分别为69.2%及63.6%,手术死亡率为0及9.1%。二者相比差异无统计学意义。结论 PVE能安全、有效地诱导肝门胆管癌术前未来残余肝增生。
Objective To investigate whether it is safe and effective to treat portal vein thrombosis in patients with hilar cholangiocarcinoma of the lesser remnant liver in the future. Methods From January 2007 to March 2009, the Affiliated East Hepatobiliary Surgery Hospital of the Second Military Medical University planned to perform a major hepatectomy. In the future, 16 patients receiving the steel ring portal vein with a residual liver / total liver volume (FLR / TLV) ratio <50% The clinical data of portal vein embolization (PVE) were analyzed. Results Twenty - six patients (PVE group) underwent PVE treatment due to liver dysfunction, PVE with FLR / TLV less than 50% and FLR / TLV> 50% in 33 patients without PVE group. Complications occurred in 3 cases after PVE due to biliary leakage and rim displacement but did not postpone the date of liver resection. Thirteen cases (81.3%) of the 16 cases were complicated with liver cirrhosis with non-embolized hepatic lobar hyperplasia and were not able to receive surgical treatment. Two cases were found tumor progression, Liver resection of the tumor resection. The incidence of surgical complications in PVE group and non-PVE group were 69.2% and 63.6% respectively, and the operative mortality rates were 0 and 9.1%. There was no significant difference between the two groups. Conclusion PVE can safely and effectively induce remnant hepatic hyperplasia of hilar cholangiocarcinoma in the future.