肝细胞癌伴门静脉癌栓不同治疗方法的疗效比较

目的 比较不同治疗方法对肝细胞癌伴门静脉癌栓的治疗效果。方法 回顾分析84例肝细胞癌合并门静脉癌栓患者的临床资料。按不同治疗方法分成5组：手术切除 癌栓取出 术后肝动脉化疗栓塞术(TACE)和胸腺肽治疗组(A组)9例;手术切除 癌栓取出 术后TACE治疗组(B组)20例;手术切除 癌栓取出组(C组)7例;TACE治疗组(D组)38例;保守治疗组(E组)10例。比较各组癌栓变化和生存期。结果A、B、C、D、E各组对癌栓治疗有效率分别为66．7％、70．0％、57．1％、7．9％和0,中位生存期分别为10．0,7．0,8．0,5．0和2．0个月,1年生存率分别为44．4％、15．0％、14．3％、10．5％和0。结论 手术切除 癌栓取出术可清除大部分癌栓,术后TACE可进一步提高患者的生存率。

Hepatocellular carcinoma with tumor thrombi in the portal vein. A comparison of therapeutic effects by different treatments

OBJECTIVE: To investigate the effects of different treatments for hepatocellular carcinoma (HCC) with tumor thrombus in the portal vein (PVTT). METHODS: From Jan. 2000 to Jan. 2003, a total of 84 HCC patients with PVTT were divided into five groups based on methed of treatment: Group A (n = 9), HCC resection + PVTT removal + postoperative TACE + thymosin alpha(1); Group B (n = 20), HCC resection + PVTT removal + postoperative TACE; Group C (n = 7), HCC resection + PVTT removal; Group D (n = 38), TACE only; Group E (n = 10), conservative treatment only. RESULTS: The rate of PVTT shrinkage or disappearance of groups A, B, C, D and E was 66.7%, 70.0%, 57.1%, 7.9% and 0, respectively with respective median survival time of 10.0, 7.0, 8.0, 5.0 and 2.0 months. The one year survival rate was 44.4%, 15.0%, 14.3%, 10.5% and 0. CONCLUSION: Resection of HCC and removal of tumor thrombus in the portal vein may have the tumor thrombus cleared in most of the patients and postoperative TACE and thymisin alpha(1) treatment may improve their survival.