原发性肝癌合并门静脉癌栓的外科综合治疗

目的探讨外科综合治疗对原发性肝癌合并门静脉癌栓的疗效。方法对87例原发性肝癌合并门静脉主干和(或)分支癌栓的患者,采用肝癌联同门静脉癌栓切除或取栓,其中73例患者术后行肝动脉化疗栓塞(TACE)。单因素分析临床病理因素对术后生存时间的影响。结果单纯手术切除组的患者中位生存期为11.2个月,其0.5,1,2,3年生存率分别64.3%、42.8%、28.5%、14.3%,肿瘤平均复发时间6.5个月。术后行TACE的患者中位生存期为19.8个月,其0.5,1,2,3年生存率分别为71.2%、60.3%、41.1%、27.4%,肿瘤平均复发时间11.5个月。明显高于单纯手术组(P<0.05)。单因素分析提示肿瘤大小(以10 cm为界)、门静脉主干是否有癌栓对术后生存有影响。结论肝癌切除术联合门静脉癌栓摘除术,是肝细胞癌合并PVTT的有效治疗方法。术后联合TACE能提高治疗效果,延长患者的生存期。

Comprehensive Surgical Treatment of Primary Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

Objective To investigate the therapeutic effects of comprehensive treatment using surgical resection and transcatheter arterial chemoembolization(TACE) on primary hepatocellular carcinoma with portal vein tumor thrombus(PVTT).Methods Eighty seven cases of primary hepatocellular carcinoma with PVTT underwent hepatic resection with removal of tumor thrombi in the main trunk or the first branch of the portal vein.Of all patients,73 cases received postoperative TACE.The clinical and pathological factors affecting their survival time after surgery were estimated by univariate analysis.Results The median survival time in the patients only treated with resection was 11.2 months and the half of year,1,2,3 year survival rates were 64.3%,42.8%,28.5% and 14.3%,respectively;The mean time of tumor recurrence was 6.5 months.But in the patients treated with following TACE,the median survival time was 19.8 months and the half of year,1,2,3 year survival rates were 71.2%,60.3%,41.1% and 17.4%,respectively;the mean time of tumor recurrence was 11.5 months,which were significantly higher than the former(P<0.05).Univariate analysis suggested that tumor size and whether tumor thrombus in the main trunk of the portal vein affected the prognosis.Conclusion Hepatoma resection and removal of portal vein thrombus is effective in the treatment for HCC with PVTT.and the postoperative TACE may have a favorable effect on the prognosis.