| 对门静脉癌栓的新认识与新实践 |
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| 引用本文： | 周存才,张小芳,魏小勇,罗庆丰.对门静脉癌栓的新认识与新实践[J].中国肿瘤临床,2022,49(15):764-768. |
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| 作者姓名： | 周存才 张小芳 魏小勇 罗庆丰 |
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| 作者单位： | 1.江西省肝肿瘤诊治中心，江西省肿瘤医院肝胆肿瘤外科（南昌市330029） |
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| 摘 要： | 肝细胞癌合并门静脉癌栓为临床常见情况，但人们对其认识仍然存在不足。本文从门静脉癌栓的形成机制、门静脉癌栓的可见度分型以及肝内播散转移的原因和机制等方面提出了一些新的认识；在这些认识的基础上，又提出“门静脉优先”理念，即术中先要分离、结扎或阻断肿瘤所在区域的门静脉，然后游离肝脏、切除肿瘤；同时提出“门静脉探查”理念，即离断肝脏时要探查断面管道有无癌栓，然后才能结扎；最后提出“门静脉原位切开直视下取栓术”，即对于程氏Ⅱ型及部分Ⅲ型癌栓，先要游离、阻断门静脉主干及对侧分支，然后切开癌栓所在部位的门静脉，直视下取出癌栓。
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| 关 键 词： | 门静脉癌栓 门静脉优先 门静脉探查 门静脉原位切开直视下取栓术 |
| 收稿时间： | 2021-11-22 |
New insights into and new practices for portal vein tumor thrombus |
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| Affiliation: | 1.Jiangxi Liver Tumor Diagnosis and Treatment Center, Department of Hepatobiliary Tumor Sugery, Jiangxi Cancer Hospital, Nanchang 330029, China2.Department of Pathology, Jiangxi Cancer Hospital, Nanchang 330029, China |
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| Abstract: | Hepatocellular carcinoma complicated with portal vein tumor thrombus (PVTT) is a common clinical predicament, and its understanding remains insufficient. Here, some new ideas on the formation mechanism of PVTT, visibility classification of PVTT, and causes and mechanism of intrahepatic dissemination and metastasis are presented. Based on these ideas, the authors put forward the concept of "portal vein priority", that is, the portal vein in the area where the tumor is located should be dissected, ligated or blocked before mobilizing the liver and removing the tumor, the concept of "portal vein exploration", that is, during parenchymal dissection, the ducts on liver section should be explored for tumor thrombus before ligation, and "thrombectomy under direct vision with portal vein in situ incision", that is, for Chen's type Ⅱ and some type Ⅲ tumor thrombi, the main portal vein and the contralateral branch should be dissected and blocked first, then the portal vein is incised at the location of tumor thrombus and the tumor thrombus is extracted under direct vision. |
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