摘要目的:研究三丙烯酸酯明胶微球(TAGM)门静脉栓塞(PVE)的安全性以及TAGM联合弹簧圈PVE与完全弹簧圈PVE诱导未来残余肝(FLR)增生的效果。方法:回顾分析2016年3月至2018年6月东方肝胆外科医院胆道一科连续完成的、因各种肝脏疾病需行大部肝切除21例患者资料。根据栓塞材料不同分为行远侧TAGM＋近侧弹簧圈PVE组(TC组)和行远侧＋近侧弹簧圈PVE组(CC组)。比较两组患者PVE后并发症、肝功能、血常规、FLR增生度、肝切除类型、手术时间、术中出血量、手术后并发症等指标。结果:TC组共纳入8例患者，其中男性、女性各4例，年龄(55.3±7.7)岁。CC组共纳入13例患者，其中男性11例，女性2例，年龄(52.6±11.3)岁。两组患者性别、年龄、疾病种类、FLR体积、FLR体积比、标准化FLR体积比、手术类型及时间、术中出血量、术后并发症、术后肝衰竭率之间差异均无统计学意义。两组患者均成功实施PVE，TC组均实现了FLR有效增长，其中1例患者因肿瘤进展未能手术；CC组有4例患者未能最终手术，其中1例患者因出现门静脉左支、主干血栓，1例患者因肿瘤进展，另外2例患者因FLR增长不足。与CC组相比，TC组FLR增生度更高[(9.0±2.8)%比(5.2±3.8)%， P<0.05]，增生速度[(11.4±7.1) ml/d比(6.9±5.2) ml/d， P>0.05]、增生率[(33.6±20.1)%比(20.9±15.1)%， P>0.05]有更高的趋势。 结论:采用TAGM联合弹簧圈行PVE安全有效，比完全弹簧圈PVE能诱导更高的FLR增生度。

abstractsObjective:To compare preoperative portal vein embolization (PVE) using tris-acryl gelatin microspheres (TAGM) versus coils.Methods:From March 2016 to June 2018, 21 consecutive patients with a future liver remnant (FLR) ratio of less than 45% before planned major hepatectomy for malignant or benign liver diseases were enrolled from the First Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital into this study. The patients were divided to receive portal vein embolization (PVE) using TAGM distally and coils proximally (the TC group) and PVE using multiple coils (the CC group). Post-PVE complications, liver function, routine blood tests; FLR hyperplasia, types of liver resection, operation time, intraoperative blood loss, and postoperative complications were compared between the two groups.Results:Eight patients were included in the TC group. There were 4 males and 4 females, with a mean age of (55.3±7.7) years. Of 13 patients included into the CC group, there were 11 males and 2 females, with a mean age of (52.6±11.3) years. There were no significant differences in sex, age, types of hepatic diseases, volume of FLR, ratio of FLR, ratio of standard FLR, types of surgery, operation duration, blood loss, major complications, and liver failure rates between the two groups. All patients in the two groups had successful PVE. The TC group developed effective growth of volume of FLR with one patient who failed to undergo surgery because of tumor progression. In the CC group, four patients failed to undergo liver resection: one patient developed thrombosis of the left branch and main trunk of portal vein; tumor progression occurred in one patient and two patients had insufficient FLR growth. Compared with the CC group, the TC group had a significantly higher volume of FLR hyperplasia [(9.0±2.8) % vs. (5.2±3.8) %, P<0.05], and a faster but insignificant increase in proliferation rate [(11.4±7.1) ml/d vs. (6.9±5.2) ml/d, P>0.05], a greater but insignificant increase in percentage of proliferation [(33.6±20.1) % vs. (20.9±15.1) %, P>0.05]. Conclusions:This study showed that PVE with TAGM plus coils is safe and effective. It induced a better degree of hypertrophy of FLR compared to PVE using multiple coils.