摘要目的:观察α-氰基丙烯酸正丁酯(NBCA)和明胶海绵作为栓塞材料的门静脉栓塞术(PVE)治疗初始不可切除肝细胞癌患者的临床疗效。方法:纳入2014年11月至2020年4月海军军医大学第三附属医院收治的行PVE治疗的90例初始不可切除肝细胞癌患者的临床资料，其中男性77例，女性13例，年龄48(25，67)岁。依据栓塞材料的不同分为两组：采用明胶海绵联合可脱解毛钢圈进行PVE的患者为明胶海绵组( n＝30)；采用NBCA联合可脱解毛钢圈进行PVE的患者为NBCA组( n＝60)。上述两组中行二期肝切除术的患者分别为NBCA切除组( n＝48)和明胶海绵切除组( n＝18)。比较患者的剩余肝体积(FLR)生长速率和二期可切除率等临床资料。以电话、短信、微信、门诊复查方式随访肝切除术后的生存情况。 结果:NBCA组的二期可切除率高于明胶海绵组[80%(48/60)比60%(18/30)]，差异具有统计学意义( P＝0.043)。NBCA切除组从一期手术到二期手术的等待时间15(7，96)d短于明胶海绵切除组的40(28，118)d，差异具有统计学意义( P<0.001)。NBCA切除组的FLR生长速率9.03(1.24，29.64)ml/d快于明胶海绵切除组的3.76(0.08，8.03)ml/d，差异具有统计学意义( P<0.001)。NBCA切除组患者术后1、2、3年无复发生存率分别为69.1%、62.0%和44.7%，总生存率分别为76.4%、69.5%和59.6%；明胶海绵切除组患者术后1、2、3年无复发生存率分别为60.6%、48.5%和35.4%，总生存率分别为66.7%、60.6%和42.4%。NBCA切除组和明胶海绵切除组肝细胞癌患者术后的无复发生存率和总生存率差异均无统计学意义(均 P>0.05)。 结论:NBCA和明胶海绵作为栓塞材料的PVE对初始不可切除肝细胞癌患者的疗效较好，但选用NBCA作为栓塞材料患者的FLR生长速率及二期可切除率更优。

abstractsObjective:To study the clinical effects of portal vein embolization (PVE) with N-butyl cyanoacrylate copolymer (NBCA) and with gelatin sponge (GS) as embolization materials in patients with initially unresectable hepatocellular carcinoma (HCC).Methods:Clinical data of 90 patients with initial unresectable HCC who underwent PVE treatment at the Third Affiliated Hospital of Naval Medical University from November 2014 to April 2020 were included. There were 77 males and 13 females, aged 48 (25, 67) years old. Patients were divided into two groups according to the embolization materials selected in PVE: NBCA group ( n=60) and GS group ( n=30). Forty-eight and 18 patients finally underwent secondary hepatectomy in NBCA group (resectable NBCA group) and GS group (resectable GS group), respectively. Clinical data including future liver remnant (FLR) growth rate and secondary hepatectomy rate were analyzed. Survivals after hepatectomy was followed up by telephone, WeChat, and outpatient review. Results:The secondary hepatectomy rate in NBCA group was higher than that in GS group [80%(48/60) vs. 60%(18/30), P=0.043]. The waiting time from primary intervention to secondary hepatectomy in resectable NBCA group was 15 (7, 96) d, which was shorter than that in resectable GS group [40 (28, 118) d, P<0.001]. The FLR growth rate of resectable NBCA group was 9.03 (1.24, 29.64) ml/d, which was faster than that in resectable GS group [3.76 (0.08, 8.03) ml/d, P<0.001]. The recurrence-free survival (RFS) rates of patients in resectable NBCA group were 69.1%, 62.0% and 44.7% at 1, 2 and 3 years after surgery, and the overall survival (OS) rates were 76.4%, 69.5% and 59.6%, respectively. The RFS rates of patients in resectable GS group were 60.6%, 48.5% and 35.4% at 1, 2 and 3 years after surgery, and the OS rates were 66.7%, 60.6% and 42.4%, respectively. There were no significant differences in RFS and OS between two groups (all P>0.05). Conclusions:PVE with NBCA and GS as embolization material showed good efficacy in patients with initially unresectable HCC. The FLR growth rate and secondary hepatectomy rate of patients using NBCA were better than those of patients using GS.