肝动脉门静脉双重栓塞术治疗肝癌对肝脏储备功能的影响

１０例原发性肝癌患者经腹脉动脉门静脉双重插管，同时化疗栓塞，并观察了术前术后肝脏储备功能指标的变化。１０例患者的肝实质栓塞率在８．３６％～４７．８％。其中４例接近或超过４０％，血浆中ｃＡＭＰ基础浓度，术前术后相比无显著变化，Ｐ＞０．０５，经胰高血糖素负荷后，ｃＡＭＰ浓度从术前的２７８．３１降至术后的１４２．３８ｐｍｏｌ／ｍｌ，Ｐ＜０．０５，４例术后ｃＡＭＰ明显低下（小于９０ｐｍｏｌ／ｍｌ）；患者术前肝动脉门静脉血流灌注指数与肝硬化时改变相似，８例中２例肝动脉门静脉血流均增加，３例肝动脉血流增加，门静脉减少，另外３例则相反；３例栓塞率较高。负荷后ｃＡＭＰ低下者出现了一过性黄疸和腹水。结果表明：①双重栓塞可损害一部分肝实质，对肝脏储备功能产生一定影响，但尚在代偿范围之内；②双栓范围较大，ｃＡＭＰ低下时注意保护功能；③双栓后肝血流的变化复杂，应进一步研究必手术操作简便，方法可靠安全。

Impact of Combined Hepatic Arterial and Portal Venous Embolization on Hepatic Functional Reserve

The changes in hepatic functional reserve of 10 patients with liver cancer who underwent combined transabdominal hepatic arterial and portal venous chemoembolization were observed. The parenchymal hepatic embolization rate (PHER) was 8. 36%-47. 8% in this series in which 4 yielded a PHER of nearly 40%. There was no significant difference in cAMP contents before glucagon loading between pre-and post-embohzation(P>0.05).However, after glucagon hading the cAMP contents decreased following embolization from 278. 31 pmol/ml to 142. 38 pmol/ml(P<0. 05). Three patients developed transient jaundice and ascites after combined embolization procedure.Before embolization the blood flow indexes of liver were similar to that of the cirrhosis.After embolization two of me 8 cases had an increase of both the hepatic artery and portal venous blood flow.And,3 of the 8 cases showed reduction in portal venous blood flow but increase of the hepatic arterial flow.And,the other three were on the contrary.In conclusion:(1)patients with liver cirrhosis tolerated fairly well with the combined embolization,(2)the procedure may damage some hepatic parenchyma but does not result in serious complications and the impaired liver function can be compensated completely,(3)with marked lowering cAMP value attention should be paid to status of liver function,(4)the Changes of the liver blood flow should be studied further.