肝癌并门静脉癌栓的外科治疗

目的:探讨术中连续门静脉灌注化疗治疗原发性肝癌并门静脉癌栓的治疗效果。方法:将38例肝癌并门静脉癌栓患者随机分为治疗组19例和对照组19例，治疗组术中实施连续门静脉灌注化疗+肝癌切除+癌栓取除术，对照组术中仅行肝癌切除+癌栓取除术。术后两组均行门静脉和/或肝动脉置管化疗。结果:A组与B组术后7 d和30 d的AFP阴性率间明显高于B组(P>0.05)，A组1，3年复发率显著低于B组(P<0.05)，1，3年生存率明显高于B组(P<0.05)。结论:术中连续门静脉灌注化疗+肝癌切除+癌栓取出术+术后门静脉和/或肝动脉置管化疗是治疗肝癌伴门静脉癌栓的一种效果较满意的方法。

Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombi

Abstract:Objective:To evaluate the effects of continous portal vein infusion chemotherapy combined with hepatectomy for treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombi(PVTT) during operation.Methods :From Apr 2001 to Apr 2004, 38 patients with HCC and PVTT were randomly divided into two groups:19 patients(group A) received continous portal vein infusion chemotherapy combined with hepatectomy, and removal of tumor thrombi;19 patients(group B) underwent only hepatectomy and removal of tumor thrombi. After operation, the two groups had treatment with hepatic artery chemotherapy (HAC) and / or portal vein chemotherapy(PVC).Results:The AFP negative rate of group A at 7 d and 30 d after operation was significantly higher than that of group B(P>0.05). The 1- and 3-year recurrence rate of group A was significantly lower than that of group B (P>0.05), and the 1- and 3-year survival rate of group A was significantly higher than that of group B (P<0.05).Conclusions:Continuous portal vein chemotherapy with hepatectomy and removal of tumor thrombi during operation, and postoperative HAC with or without PVC is an effective approach for treatment of HCC with poratal vein tumor thrombi.