肝切除联合经导管化学药物治疗伴有门静脉癌栓的肝癌40例报告

目的 探讨非规则性肝切除及癌栓摘除术联合肝动脉化学药物治疗（化疗）（hepatic artery chemotherapy,HAC)及门静脉化疗（portal vein chemotherapy,PVC)治疗肝细胞癌（hepatocellular carcinoma,HCC)合并门静脉癌栓（portal vein tumor thrombi,PVTT)的价值。方法 总结1987年1月－1996年12月采用非规则性肝切除及癌栓摘除术治疗HCC合并PVTT的患者62例，其中，40例在术后联合HAC和PVC。59例获随访3年。结果 6例在术后3个月内死于肝、肾功能衰竭，56例术后恢复良好。术后1、2、3年的复发率和生存率，在手术后应用HAC和PVC组分别为46％（18／39）、59％（23／39）、79％（31／39）和69％（27／39）、51％（20／39）、31％（12／39），而在未化疗组分别为80％（16／20）、90％（18／20）、100％（20／20）和30％（6／20）、10％（2／20）、5％（1／20）。结论 非规则性肝切除和癌栓摘除术是HCC合并PVTT有效的治疗方法，术后联合HAC和PVC可降低复发率、提高生存率。

Hepatectomy combined with intraarterial and intraportal chemotherapy for the tre atment of hepatocellular carcinoma

Objective To evaluate irregular hepatectomy combined with removal of tumor thrombi, postoperative hepatic artery chemotherapy(HAC) and portal vein chemotherapy (PVC) for the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombi (PVTT). Methods From Jan. 1987 to Dec. 1996, 62 HCC cases with PVTT underwent the combined therapy. Among them HAC and PVC were given in 40 cases. 59 patients were followed up for over 3 years. Results 6 cases died of postoperative hepatic and renal failure in 3 months. Recurrent rate and survival rate at 1, 2, 3 year was 46%(18/39), 59%(23/39),79%(31/39)and 69%(27/39),51%(20/39), 31%(12/39) respectively in group of combined HAC and PVC compared with 80%(16/20),90%(18/20),100%(20/20)and 30%(6/20),10%(2/20), 5%(1/20)in group without postoperative HAC and PVC. Conclusions Irregular hepatectomy with removal of tumor thrombi is an effective treatment for HCC with PVTT. Postoperative use of HAC and PVC significantly reduces the recurrence rate and improves survival.