双途径化疗治疗肝癌并发门静脉癌栓患者对预后的影响

目的探讨经药物传输泵(DDS)门静脉化疗(PVC)联合肝动脉插管化疗栓塞(TACE)]治疗肝细胞癌伴门静脉癌栓的临床疗效及安全性。方法对87例肝细胞癌合并门静脉癌栓患者手术切除肿瘤并取出癌栓,再随机将患者分成3组。A组行TACE、B组行经DDS泵PVC,C组行经DDS泵PVC联合TACE。随访3年。结果 C组患者术后6个月、1年、2年和3年无瘤生存率分别为93.5%、80.6%、41.9%和29.0%,累积生存率分别为96.8%、87.1%、54.8%和45.2%,其中2年和3年生存率显著高于A组和B组(P均<0.05);C组患者术后6个月、1年、2年和3年上消化道出血发生率分别为0%、0%、16.1%和22.6%,与A组和B组比无显著性差异(P均>0.05)。结论对肝细胞癌合并门静脉癌栓患者行手术切除肿瘤并取出癌栓后,行双途径化疗可有效提高患者无瘤生存率及累计生存率。

A three year-followed up of patients with hepatocellular carcinoma complicated by portal vein tumor ;thrombus receiving TACE and PVC after resection of tumors

Objective To observe the survival of patients with hepatocellular carcinoma（HCC）complicated by portal vein tumor thrombus （PVTT）receiving transcatheter arterial chemoembolization （TACE）and portal vein chemotherapy（PVC）after resection of tumors. Methods Eighty-seven patients with HCC complicated by PVTT had tumor resection and removal of PVTT. After the operation,the patients were randomly divided into three groups. The patients in group A,B and C were treated by TACE,by PVC and by TACE combined with PVC,respectively. The patients in the three groups were followed-up for three years. Results The tumor free survivals in group C six months,one year,two years and three years after the treatment were 93.5%,80.6%,41.9% and 29.0%,and the accumulative survival rates were 96.8%,87.1%,54.8% and 45.2%,respectively. Out of them,the survivals at two and three years were much higher than those in group B and C （P〈0.05）;the incidence of upper gastrointestinal bleeding in group C in six months,one year,two years and three years were 0%,0%,16.1% and 22.6%,respec-tively,without significant difference as compared to those in group A and B （P均〉0.05）. Conclusion The TACE and PVC are alternative approach in patients with HCC complicated by PVTT,which might improve the tumor-free survival and the accumulative survival rates.