16 肝细胞癌合并脉管系统癌栓的外科治疗

目的:探讨肝细胞癌（HCC）合并脉管系统癌栓的外科治疗效果。方法:回顾性分析1993年1月—2002年1月采用肝切除和癌栓取出术治疗HCC合并脉管系统癌栓68例的临床资料，其中门静脉癌栓63例，肝左静脉癌栓1例，肝中静脉癌栓合并门静脉左支癌栓1例，肝右静脉、下腔静脉合并门静脉右支癌栓1例，下腔静脉癌栓2例。HCC合并门静脉癌栓患者中6例术后行门静脉化疗。结果:6例术后3个月内死于肝肾功能衰竭， HCC合并脉管系统癌栓患者术后1，3，5年生存率分别为41.7%，20.8%，4.1%。结论:肝切除并癌栓取出术是HCC合并脉管系统癌栓有效的治疗方法，术后辅助治疗能提高治疗的效果。

Surgical treatment for hepatocellular carcinoma with tumor thrombi in the vascular system

Objective To study the value of surgical treatment for hepatocellular carcinoma(HCC) with tumor thrombi in vascular system.Methods The clinical data of 68 patients of HCC with tumor thromb in the vascular system who underwent hepatic resection with tumor thrombectomy,from Jan 1993 to Jan 2001,were retrospectively analyzed.Among them,63 patients had tumor thrombus of portal vein,1 patient had tumor thrombus of left hepatic vein,1 patient had tumor thrombus of middle hepatic vein and left branch of portal vein,1 patient had tumor thrombus of right hepatic vein,inferior vena cava and right branch of portal vein,and 2 patients had tumor thrombus of inferior vena cava.Six patients with tumor thrombus of portal vein caused by HCC underwent portal vein chemotherapy(PVC) after operation.Results Six patients died from liver and kidney function failure 3 months after operation;62 patients made a good recovery.The 1-,3-and 5-year survival rate was 41.7%,20.8% and 4.1%,respectively.Conclusions Hepatic resection with tumor thrombectomy is effective in treatment of HCC with tumor thrombi in vascular system.After operation,adjuvant treatment can have a favourable effect on the prognosis.