合并门静脉癌栓的原发性肝癌的手术治疗及预后分析

目的:评价手术治疗合并门静脉癌栓(PVTT)的原发性肝癌(PHCC)的疗效和影响患者术后生存的预后因素。方法:对26例在我院行手术治疗的PHCC合并PVTT患者的资料进行回顾性分析并进行随访,计算术后生存率和中位生存时间,单因素分析11项临床病理因素对术后生存时间的影响。结果:手术采用肝癌切除术联合门静脉癌栓摘除术。术后总的1,2,3年生存率为50%,16.7%和8.3%,中位生存时间为13个月。术后定期行门静脉或肝动脉灌注化疗,患者的中位生存时间为16.1个月,而单纯手术者为7.2个月,两者差异有显著性(P=0.001)。单因素分析提示术后是否化疗和肿瘤大小(以10cm为界限)对术后生存有影响。结论:手术治疗可明显提高PHCC合并PVTT患者的生存时间,对没有禁忌证者应为首选。术后是否化疗和肿瘤大小影响术后生存时间,术后应常规进行化疗。

Surgical therapy and prognostic analysis for patients of terminal hepatocellular carcinoma with portal vein thrombus

Objective:To evaluate the effect of surgical therapy on the patients of terminal hepatocellular carcinoma with portal vein thrombus and to clarify the prognostic factors affecting the survival time.Methods:Retrospective analysis for the data of 26 patients of terminal hepatocellular carcinoma with portal vein thrombus who have undergone an operation in our hospital and their follow-ups were made.Survival rate and mean survival time were computed,11 clinical and pathological factors affecting their survival time after surgery were estimated by univariate analysis.Results:All the patients were underwent the hepatoma recection and removal of portal vein thrombus.The overall rates of 1,2,3year survival rates after surgery were 50%,16.7% and 8.3%,and the mean survival time was 13 months.The mean survival time of the patients who underwent the infusion chemotherapy of portal vein or hepatic artery after surgery was 16.1 months,while the time of those who underwent only the surgery was 7.2 months which was significantly shorter than the former(P=0.001).Univariate analysis suggested that infusion chemotherapy of portal vein or hepatic artery after surgery and tumor size affected the prognosis.Conclusion:Surgical therapy can significantly increased the survival time for the patients of terminal hepatocellular carcinoma with portal vein thrombus,which should be firstly considerated for patients.Infusion chemotherapy after surgery and tumor size affect the prognosis,and the infusion chemotherapy should be routinely undergone after surgery.