两种栓塞方法行超选择性肝动脉栓塞术治疗多囊肝病的对比研究

摘要

目的 比较两种栓塞方法行超选择性肝动脉栓塞术( TAE)治疗多囊肝病的疗效及安全性.方法 回顾分析解放军总医院第一医学中心2008年6月至2016年6月行TAE的41例多囊肝病患者资料,其中男性5例,女性36例,年龄36～68岁.根据栓塞方案不同分为观察组(n=14)和对照组(n=27).观察组采用博来霉素+α氰基丙烯酸正丁酯+碘油,对照组为α氰基丙烯酸正丁酯+碘油.记录术后有无并发症.术后3、6 个月及此后每6 个月定期复查,评估症状改善情况、腹围、肝内囊肿总体积及肝脏总体积.结果 两组均成功行TAE,无严重并发症.观察组术后3、6、12、24个月症状明显改善率为92. 9% (13/14)、92. 9% (13/14)、92. 9% (13/14)、92. 3% (12/13),术后24个月失访1例.对照组术后3、6、12、24 个月症状明显改善率为88. 9% (24/27)、85. 2% (23/27)、84. 6% (22/26)、81. 8% (18/22).术后12个月失访1例,术后24个月失访5例.与本组术前比较,两组术后腹围均减小,术后6、12、24个月肝内囊肿总体积及肝脏总体积均减小,差异有统计学意义(P＜0. 05).结论 应用博来霉素+α氰基丙烯酸正丁酯+碘油及α氰基丙烯酸正丁酯+碘油行TAE治疗多囊肝病安全、有效,且前者疗效优于后者.%Objective To compare the effectiveness and safety of two different treatment methods for patients with polycystic liver disease using super selective hepatic arterial embolization. Methods This retrospective study enrolled 41 patients with polycystic liver disease treated from June 2008 to June 2016 in the First Medical Center of Chinese PLA General Hospital. The patients underwent transcatheter super-selective hepatic arterial embdization (TAE). There were 5 men and 36 women. The age ranged from 36 to 68 years. The patients were divided into the observation group (n=14) and the control group ( n=27). The observation group underwent treatment using an emulsion of iodized oil and bleomycin and N-butyl-2-cyanoacrylate. The control group underwent iodized oil and N-butyl-2-cyanoacrylate. The clinical symptoms, operative complications, volumes of intrahepatic cysts, hepatic parenchyma volumes of pre-TAE and post-TAE at 3, 6 months and every 6 monthly were compared. Results TAE was technically successful in all the patients. The follow-up periods ranged from 24 to 72 months. The clinical symptoms improved re-markably in the observation group at 3 month, 6 months, 12 months, and 24 months, being 92. 9% (13/14), 92. 9% (13/14), 92. 9% (13/14), 92. 3% (12/13), respectively. One patient was lost to follow-up 24 months after operation. The clinical symptoms improved remarkably in the control group at 3 month, 6 months, 12 months, and 24 months, being 88. 9% ( 24/27 ), 85. 2% (23/27), 84. 6% ( 22/26 ), 81. 8% (18/22), respectively. One patient was lost to follow-up 12 months after operation and five patients were lost to follow-up 24 months after operation. Compared with preoperative, the abdominal circumference of two groups had decreased, the total volume of intrahepatic cyst and liver decreased at 6 months, 12 months, and 24 months after surgery (P＜0. 05). Conclusions TAE was a safe and effective treatment for polycystic liver disease. Patients in the observation group had more effective treatment outcomes on follow-up.