肝癌合并门静脉癌栓术后两种治疗方式比较

目的比较肝癌合并门静脉癌栓术后两种治疗方式的疗效。方法回顾性分析我科2006年6月至2011年12月期间收治并经随访的51例肝细胞癌合并门静脉主干或门静脉左右主分支癌栓患者的临床资料,51例患者均行手术完整切除病灶,术后除给予提高免疫力和抗病毒治疗外,并按术后化疗方式不同分为门静脉置泵化疗组(portal vein infusion drug deliver system,PVIDDS,n=19)和肝动脉化疗栓塞组(transcatheter arterial chemo-embolization,TACE,n=32),比较2组患者的疗效。结果术后1个月、1年、3年和5年复发率TACE组分别为3.1%(1/32)、46.9%(15/32)、84.4%(27/32)和100%(32/32),PVIDDS组分别为5.3%(1/19)、52.6%(10/19)、100%(19/19)和100%(19/19),2组术后1个月、1年和5年复发率差异无统计学意义(P>0.05),术后3年复发率TACE组低于PVIDDS组(P<0.05)。TACE组和PVIDDS组的中位生存期(17.1个月比15.9个月)、1年及3年生存率(93.8%比94.7%,40.6%比36.8%)差异均无统计学意义(P>0.05),5年生存率TACE组高于PVIDDS组(21.9%比0,P<0.05)。TACE组并发症发生率低于PVIDDS组(65.6%比94.7%,P<0.05)。结论肝癌合并门静脉主干或门静脉左右主分支癌栓如果能手术则尽量完整切除病灶,术后应给予抗病毒、提高免疫力、化疗等治疗;肝动脉化疗栓塞的疗效优于门静脉化疗。

Compare The Effects of Two Chemotherapeutic Patterns after Hepatectomy of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

Objective To compare the effect of two chemotherapeutic patterns after hepatectomy of hepatocellular carcinoma(HCC)with portal vein tumor thrombi(PVTT).Methods The clinical data of 51 HCC patients with PVTT who were treated in our department from June 2006 to December 2011 were analyzed retrospectively.Fifty-one HCC patients with PVTT who were performed hepatectomy and treatment of antivirus and improve immune were divided into two groups according to chemotherapeutic patterns after operation:portal vein infusion drug deliver system(PVIDDS) group(n=19)and transcatheter arterial chemoembolization(TACE)group(n=32),and to compare the treatment effect of the two groups.Results The recurrence rate of 1-month,1-year,3-year,and 5-year after operation in TACE group was 3.1%(1/32),46.9%(15/32),84.4%(27/32),and 100%(32/32),respectively.And in PVIDDS group,which was 5.3%(1/19),52.6%(10/19),100%(19/19),and 100%(19/19),respectively.There were no differences in recurrence rate of 1-month,1-year,and 5-year after operation in two groups(P > 0.05).Recurrence rate of 3-year after operation in TACE group was lower than that in PVIDDS group(P < 0.05).There were no differences in medial survival time(17.1 months vs.15.9 months),survival rate of 1-year(93.8% vs.94.7%)and 3-year(40.6% vs.36.8%)after operation in TACE group and PVIDDS group(P>0.05).Survival rate of 5-year after operation in TACE group was higher than that in PVIDDS group(21.9% vs.0,P<0.05).The rate of complication in TACE group was lower than that in PVIDDS group(65.6% vs.94.7%,P<0.05).Conclusions If the HCC patients with PVTT could endure operation,surgical resection should be considered firstly,furthermore antivirus treatment,improving immune,and chemotherapy should be considered after operation.The effect of TACE is better than PVIDDS.