肝细胞癌合并门静脉癌栓的手术切除及疗效观察

目的 探索肝细胞癌合并门静脉癌栓（ＰＶＴＴ）手术切除的疗效及其影响预后因素。方法 总结近１０年１１１例肝细胞癌合并门静脉主干或第一分支癌栓的患者,均行肝癌联同门静脉左或右支癌栓切除或经左、右支断端取栓或切开主干取栓,其中２２例患者切除肿瘤及癌栓后行肝动脉和（或）门静脉插管。３２例患者术后经肝动脉化疗栓塞和（或）经门静脉导管化疗。另１４例ＰＶＴＴ患者仅行保守治疗（非手术组）,２０例ＰＶＴＴ患者行探查

Hepatic resection with removal of tumor thrombi for hepatocellular carcinoma with tumor thrombi in portal vein and curative analysis

Objective To study the therapeutic effects of surgical treatment for hepatocellular carcinoma (HCC) with tumor thrombi in the main trunk or the first branch of the portal vein (PVTT) and factors affecting prognosis. Methods 111 HCC patients with PVTT underwent hepatic resection with removal of tumor thrombi in the first left or the right branch of the portal vein or removal of tumor thrombi by direct opening of the main trunk of the portal vein. Hepatic artery infusion and/or portal vein infusion were performed after hepatic resection with removal of tumor thrombi for HCC with PVTT in 22 of the patients. Among 111 patients, 32 received postoperative transhepatic arterial chemoembolization and/or portal vein chemotherapy.Conservative treatment and surgical exploration or hepatic artery ligation (HAL) and infusion (HAI) and/or portal vein infusion (PVI) were performed in other 14 and 20 HCC patients with PVTT, respectively. Results The 1 , 2 , 3 , 4 and 5 year survival rates were 61 7%, 36 2%, 32 3%, 24 4% and 22 4% in the resected group, respectively, whereas 14 HCC patients with PVTT treated conservatively died in three months and the 1 , 2 year survival rates were 6 0% and 0 in the 20 patients with surgical exploration or HAL and HAI and/or PVI respectively. Conclusions Hepatic resection with removal of tumor thrombi for HCC with PVTT should be encouraged for the prolongation of life span and quality of life.