剩余肝体积不足肝癌的转化治疗策略

Conversion therapy strategies for hepatocellular carcinoma with insufficient future liver remnant

  • 摘要: 剩余肝体积不足是导致肝癌初始不可切除的主要原因之一。通过手术或介入治疗可促进肝体积增生,从而实现剩余肝体积不足肝癌的转化后切除。常用的促进肝体积增生的方法包括门静脉结扎、门静脉栓塞、联合肝脏分隔和门静脉结扎的二步肝切除术、肝静脉剥夺术。上述4种治疗方式均具有促进肝体积增生的作用,但在安全性和促进肝体积增生的效率等方面也存在差异。随着肝癌外科治疗、局部非手术治疗、系统治疗理念和方法的持续发展,以多学科综合治疗理念为指引,结合患者具体情况和团队诊断与治疗经验、技术条件,通过个体化、多模式、多维度的综合治疗将剩余肝体积不足肝癌转化为可根治性切除,有助于进一步改善肝癌患者生存预后。笔者综合相关研究进展,深入阐述剩余肝体积不足肝癌转化治疗的策略、方法和未来发展趋势。

     

    Abstract: Insufficient future liver remnant is one of the main reasons for initially unresectable of hepatocellular carcinoma (HCC). Surgical or interventional treatments can promote the hypertrophy of insufficient remnant liver, thus enabling the post-conversion resection of HCC. Commonly used methods to promote liver hypertrophy include portal vein ligation, portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy, and liver venous deprivation. All of these four treatmental methods can promote liver hypertrophy, but there are also certain differences in terms of safety and the efficiency of promoting liver hypertrophy. With the continuous development of concepts and methods in surgical treatment, local non-surgical treatment and systemic therapy of HCC, individualized, multi-mode, and multi-dimensional comprehensive treatments guided by the concept of multidisciplinary comprehensive treatment and combined with the specific situation of patients, team diagnosis and treatment experience, and technical conditions, are being widely used in the conversion therapy of HCC with insufficient future liver remnant, and help to further improve the survival prognosis of HCC patients. Herein, the authors comprehensively review relevant research progress and elaborate on the strategies, methods, and future development trends of conversion therapy for HCC with insufficient future liver remnant.

     

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