肝细胞性肝癌合并门静脉癌栓63例临床治疗分析

目的:比较不同治疗方法对肝细胞性肝癌(HCC)合并门静脉癌栓(PVTT)的疗效及其意义。方法:回顾性分析应用不同治疗方式治疗的63例原发性HCC合并门静脉主干或者第一分支癌栓患者的预后。按照治疗方式的不同分为4组:保守治疗组(A组,7例);TACE治疗组(B组,19例);手术切除原发HCC同时行门静脉切开取栓术或者癌栓部位门静脉切除术治疗组(C组,12例);手术切除原发HCC同时行门静脉切开取栓术或者癌栓部位门静脉切除术+术后TACE治疗组(D组,25例)。结果:A组中位生存期为2个月,半年、1年、2年、3年生存率分别为14%、0、0、0;B组中位生存期为6个月,半年、1年、2年、3年生存率分别为56%、12%、0、0;C组中位生存期为10个月,半年、1年、2年、3年生存率分别为、74%、37%、9%、0;D组中位生存期为16个月,半年、1年、2年、3年生存率分别为80%、52%、20、12%。各组生存率比较差异均具有统计学意义(P<0.05)。结论:原发性HCC合并PVTT采取手术切除原发肝癌同时行门静脉切开取栓术或者癌栓部位门静脉切除术可明显延长生存期,术后应用TACE治疗可进一步延长生存期,提高生存率。

Therapeutic effects analysis of sixty-three cases of hepatocellular carcinoma with portal vein tumor thrombus

Objective： To evaluate the efficacy of different treatment strategies for primaryhepatocellular carcinoma（HCC）with portal vein tumor thrombus（PVTT）through sixty-three cases of HCC with PVTT.Methods： Sixty-three HCC patients with PVTT in the first branch and/or main trunk of the portal vein were enrolled in this study.They were divided into four groups and underwent four different treatment.Group A,conservative treatment group,（n=7）.Group B,TACE treatment group（n=19）;Group C,surgical resection group（,n=12）;Group D,surgical resection and TACE group（n=25）.Results： The median survival time of the patients in Group A、B、C、D were 2 months 、6 months、10 months、16 months respectively;and the survival rates at 0.5-,1-,2-,and 3-year of the patients in Group C、D were 74%、37%、9%、0 respectively;and the survival rates at 0.5-,1-,2-,and 3-year of the patients in Group D were 80%、52%、20、12% respectively.Conclusion： Resection of HCC and removal of PVTT may prolong the survival period of patients with HCC and PVTT.Treatment of postoperative TACE may improve their survival.