原发性肝癌伴门静脉癌栓的治疗方式探讨

目的　探讨原发性肝癌 (HCC)伴门静脉癌栓 (TTPV )的有效治疗方式。方法　回顾性分析和总结 1995年 1月至 2 0 0 3年 5月期间收治的 95例原发性肝癌伴门静脉癌栓患者的临床资料。结果　 5 8例行手术治疗 ,其中 6例行单纯肝肿瘤切除术 ,1、3年生存率为 3 3 .3 %、0 % ;5 2例行肝肿瘤切除加门静脉癌栓取栓术 ,其中 43例术后采用了肝动脉和门静脉双插管微量泵灌注化疗 ,其 1、3、5年生存率为 10 0 %、5 5 .8%、13 .9% ,9例未行插管化疗 ,1、3、5年生存率为 77.7%、2 2 .2 %、0 %。另 3 7例未行手术者中 10例行单纯肝动脉栓塞 (HAE) ,1、3年生存率为 2 0 %、0 % ;2 1例行选择性门静脉栓塞 (SEPV)联合肝动脉栓塞 ,1、3、5年生存率为 71.4%、2 8.6%、9.5 % ;6例未作任何治疗者均 1年内死亡。结论　手术治疗原发性肝癌伴门静脉癌栓有效 ,术后使用肝动脉和门静脉双插管灌注化疗可提高疗效 ,选择性门静脉栓塞联合肝动脉栓塞对不能切除的肝癌伴门静脉癌栓有重要作用

Treatment of primary hepatic cancer with portal venous tumor thrombosis

Objective To study the effective methods of the treatment for hepatocellular carcinoma (HCC) with tumor thrombi in portal vein.Methods The clinical data of 95 HCC patients with tumor thrombi in portal vein collected during Jan.1995 and May 2003 were analyzed.Results Of 58 patients subject to surgical treatment,6 received simple hepatoma resection,and the 1-,3-year survival rate was 33.3% and 0 respectively.In the remaining 52 patients undergoing hepatoma resection in combination with removal of tumor thrombi,43 received hepatic artery and portal vein chemoembolization with the 1-,3-,5-year survival rate being 77.7%,22.2%,0 respectively,while in the 9 without receiving chemoembolization,the 1-,3-year survival rates was 20% and 0 respectively.Of the other 37 patients not subject to surgical treatment,10 underwent hepatic artery embolization (HAE) and the 1-,3-year survival rate was 20%,0 respectively,while in 21 undergoing selective embolization of portal vein (SEPV) combined with hepatic artery embolization,the 1-,3-,5-year rate was 71.4%,28.6%, 9.5% respectively,and 6 patients without any treatment died in 1 year.Conclusion Surgical treatment for HCC is effective.Chemoembolization after operation can enhance the effect.Selective embolization of portal vein and hepatic artery play an important role in the treatment for HCC with tumor thrombi in portal vein.