摘要目的:探讨在原发性肝癌二期切除手术前行肝静脉剥脱术(LVD)的效果和安全性。方法:回顾性分析2018年1月至2019年1月在新乡市中心医院肝脏外科行手术治疗的不宜一期手术切除的中晚期原发性肝癌患者56例，其中在肝切除术前行门静脉栓塞术(PVE)30例(PVE组)，行PVE+LVD 26例(LVD组)。比较两组患者LVD或PVE前后剩余肝体积(FLR-V)、肝储备功能的动态变化以及两组患者的二期手术准备时间、二期手术切除率、R0切除率、手术并发症、术后复发率及生存率。结果:LVD组与PVE组患者穿刺栓塞成功率均为100%。栓塞治疗后，LVD组发生Ⅰ、Ⅱ、Ⅲ级并发症者分别有12、3和1例，PVE组分别有10、2和1例，均未发生Ⅳ级并发症，两组差异无统计学意义( P＝0.808)。LVD组患者栓塞前、栓塞后7、14和21 d的FLR-V分别为(493.1±25.8)、(673.2±56.1)、(779.5±81.6)和(853.3±85.2)cm 3，PVE组患者栓塞前、栓塞后7、14和21 d的FLR-V分别为(502.4±20.1)、(688.6±43.9)、(656.8±73.7)和(563.5±69.1)cm 3。栓塞前、栓塞后7 d两组FLR-V差异均无统计学意义(均 P>0.05)，栓塞后14和21 d LVD组FLR-V高于PVE组(均 P<0.01)。LVD组二期肝切除准备时间为(20.4±6.3)d，短于PVE组[(31.5±8.8)d， P＝0.045]；二期肝切除率为92.3%(24/26)，高于PVE组[70.0%(21/30)， P＝0.036]；R0切除率为87.5%(21/24)，高于PVE组[57.1%(12/21)， P＝0.022]，但两组的手术方式、手术时间、术中出血量、Clavien-Dindo并发症分级和住院时间差异均无统计学意义(均 P>0.05)。肝切除术后，LVD组的中位复发时间和中位生存时间分别为12.6和21.3个月，均比PVE组(分别为9.4和13.5个月)长(均 P<0.01)。 结论:对于不宜一期切除的中晚期原发性肝癌患者，肝切除术前行LVD能够显著增加FLR-V，提高二期手术切除率，缩短二期肝切除准备时间，提高二期手术R0切除率，并不增加手术并发症，且行LVD患者的术后复发时间和生存时间长于行PVE的患者，远期治疗效果较好。

abstractsObjective:To investigate the efficacy and safety of liver venous deprivation (LVD) before secondary resection of primary liver cancer.Methods:56 patients with advanced primary liver cancer who were not suitable for primary resection in Liver Surgery Department of Xinxiang Central Hospital from January 2018 to January 2019 were analyzed retrospectively. They were divided into liver vein deprivation group (LVD group: LVD+ PVE, n=26) and portal vein embolization group (PVE group, n=30). The dynamic changes of liver reserve function and future liver remnant volume (FLR-V), R0 resection rate, surgical complications, postoperative recurrence rate and overall survival rate of two groups before and after LVD/PVE were compared. Results:The success rate of puncture and embolization in LVD group and PVE group was 100%. There were no grade Ⅳ complications, and there was no significant difference of grades Ⅰ, Ⅱ and Ⅲ complications between the groups ( P=0.808). The FLR-V of LVD group before embolization, 7, 14 and 21 days after embolization was (493.1±25.8), (673.2±56.1), (779.5±81.6) and (853.3±85.2) cm 3, respectively. The FLR-V of PVE group before embolization, 7, 14 and 21 days after embolization were (502.4±20.1), (688.6±43.9), (656.8±73.7) and (563.5±69.1) cm 3, respectively. There was no significant difference in FLR-V between the two groups before and 7 days after embolization ( P>0.05). The FLR-V of LVD group was higher than that of PVE group at 14 and 21 days after embolization ( P<0.01). The preparation time of LVD group was (20.4±6.3) days, which was shorter than that of PVE group [(31.5±8.8) days, P=0.045]. The rate of secondary hepatectomy was 92.3% (24/26), which was higher than that of PVE group [70.0% (21/30), P=0.036]. The R0 resection rate was 87.5% (21/24), which was higher than that of the PVE group [57.1% (12/21), P=0.022]. However, there were no significant differences in surgical methods, operation time, intraoperative blood loss, Clavien-Dindo complication grade and length of hospital stay between the two groups ( P>0.05). After hepatectomy, the median recurrence time and median survival time of LVD group were 12.6 months and 21.3 months, respectively, which were longer than those of PVE group (9.4 months and 13.5 months, respectively, P<0.01). Conclusions:For patients with advanced liver cancer who are not suitable for primary hepatectomy, preoperative LVD can significantly increase FLR-V, improve the resection rate of secondary surgery, shorten the preparation time of two operations, and do not increase surgical complications. Moreover, patients with LVD can improve the R0 resection rate of secondary surgery. The postoperative recurrence time and overall survival rate of patients with LVD are better than those of patients with PVE, and LVD has a good long-term effect.