Objective To discuss the therapeutic effect and the safety of selective portal vein embolization (PVE) combined with transcatheter arterial chemoembolization (TACE) in the treatment of hepatic metastatic carcinomas. Methods A total of 49 patients with hepatic metastatic carcinomas, who were unable to undergo or refused to receive surgical resection of liver, were enrolled in this study. The patients were divided into control group (n = 26) and study group (re = 23). Only TACE was performed in the patients of the control group, while PVE together with TACE was carried out in the patients of the study group. After the treatment, the liver function, liver volume, untoward effects, postoperative complications , the short-term curative effects and cumulative survival rates of both groups were determined, and the results were compared between the two groups. Results (1) Six months after the treatment the effective rate of the study group was 65.2% (15/23), which was significantly higher than that of the control group (30.8% , 8/26) with P = 0.04. In the study group, the longest diameter of the tumor decreased from preoperative (9.92 ± 2.63) cm to postoperative (7.32 ± 2.61 )cm. In the control group the longest diameter of the tumor decreased from preoperative (10.34 ± 3.12)cm to postoperative (9.13 ± 3.42)cm. The results of the study group was superior to that of the control group (P= 0.04). The median survival time of the study group and the control group was 21 months and 13 months,respectively.Significant difference in cumulative survival rate existed between the two groups (P < 0.05). (2) After the treatment, no obvious change in liver volume was seen in the control group. In the study group , the preoperative volume of non-embolized liver lobe was (481 ± 2 51)cm3, which enlarged to (523 ± 250 )cm3, (548 ± 249 )cm3 and (552 ± 249)cm3 at two, four and eight weeks after the treatment, respectively. And the percentage of these increases was (10.1 ± 7.6)%, (16.1 ± 10.9)% and (17.2 ± 11.5)%, respectively. (3) After the treatment, no obvious change in serum albumin level was found in both groups. In the study group the ALT , AST and TB levels were markedly elevated at the first and third day after the operation , then they dropped at the seventh day (P > 0.05). The ALT, AST and TB levels in the study group at the first and third day after the operation were higher than those in the control group. But the differences in the ALT , AST and TB levels at the seventh and fourteenth day between the two groups were of no significance. Conclusion Selective portal vein embolization combined with transcatheter arterial chemoembolization can effectively control and reduce the hepatic metastatic carcinomas , improve the patient s cumulative survival rate. Therefore , this combination use of PVE and TACE is a safe and effective treatment for inoperable hepatic metastatic carcinomas.(J Intervent Radiol, 2012, 21: 384-390)%目的 探讨选择性门静脉栓塞术(PVE)联合肝动脉化疗栓塞术(TACE)治疗肝转移癌的疗效和安全性.方法 将49例无法或拒绝接受手术切除肝转移癌的患者分为对照组和治疗组.对照组(26例)单纯行TACE,治疗组(23例)在此基础上联合选择性门静脉栓塞术,观察比较2种疗法对患者术后肝功能、肝脏体积、不良反应、并发症及近期疗效和累积生存率的影响.结果 ①术后6个月治疗组有效率65.2%(15/23)高于对照组30.8%(8/26)(P ＝ 0.04);治疗组肿瘤最长径总和由术前(9.92 ± 2.63)cm下降为术后(7.32 ± 2.61)cm,对照组由术前(10.34 ± 3.12)cm下降为术后(9.13 ± 3.42)cm,治疗组优于对照组;治疗组和对照组中位生存时间分别为21个月及13个月,累积生存率比较P ＜ 0.05.②肝脏体积变化比较:对照组术后肝脏体积无明显变化;治疗组术前非栓塞叶体积为(481 ± 251)cm3,术后2,4,8周分别为(523 ± 250)cm3,(548 ± 249)cm3,(552 ± 249)cm3,分别比术前增加(10.1 ± 7.6)%,(16.1 ± 10.9)%,(17.2 ± 11.5)%.③术后肝功能:两组患者术后血浆白蛋白水平变化均不明显,治疗组术后第1,3天,ALT、AST、TB等指标较术前明显升高,至术后第7天下降(P ＞ 0.05).两组相比,术后第1天、第3天ALT、AST、TB治疗组高于对照组,第7、14天差异无统计学意义.结论 选择性PVE联合TACE能够有效的控制和缩小肝转移癌,改善患者累积生存率,是治疗无法手术切除肝转移癌安全有效的选择,值得进一步研究应用.
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