Objective: To analyze the efficacy of branches portal vein embolization (TBPVE) combined with transcatheter arterial chemoembolization (TACE) on liver neoplasms. Methods: 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. Results: On the 7thday 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 14thday 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. Conclusions: 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.
目的： 探讨末梢门静脉栓塞(TBPVE)联合经动脉化疗栓塞(TACE)在肝脏恶性肿瘤治疗中的效果。 方法： 2016年8月至2017年5月同一手术团队对13例肝脏恶性肿瘤患者实施TBPVE联合TACE治疗，男性11例，女性2例，平均年龄(60.8±6.2)岁。术前均诊断为原发性肝癌，其中11例患者伴有乙肝病史，术前肝功能状态均为Child－Pugh A级。使用患者的CT或MRI扫描数据进行肝脏三维重建，术前标准肝体积(SLV)平均为(1 181.2±49.3)ml，预计剩余肝脏体积(FLR)平均为(326.1±72.1)ml，FLR/SLV平均为(27.6±6.0)%，按照门静脉三维成像模型确定末梢门静脉栓塞方案和肝动脉化疗方案。术后1、2周复查CT或MRI，计算FLR/SLV及肝脏增生率，根据患者意愿及增生情况施行手术治疗。检测栓塞前、术后1周甲胎蛋白(AFP)水平，同时分析术后并发症发生情况。 结果： 栓塞术后第7天，13例患者的FLR/SLV平均为(42.6±8.0)%，术后第14天FLR/SLV平均为(45.8±6.2)%。栓塞术后第7天对侧肝脏平均增长(56.0±24.6)%，术后第14天平均增长(71.8±29.0)%。栓塞术后第7天AFP水平由术前的(87.9±81.8)μg/L降至(29.7±20.9)μg/L。4例患者在栓塞术后2周内接受手术治疗，2例行右半肝切除，2例行右三肝切除。9例患者在行TACE术时注射碳酸氢钠。所有患者均未发生严重并发症。 结论： TBPVE联合TACE能使肿瘤体积缩小，可能可以作为治疗肝癌的一种新模式。.
Keywords: Hepatectomy; Liver neoplasms; Terminal branches portal vein embolization; Transcatheter arterial chemoembolization.