伴门静脉癌栓的原发性肝癌外科治疗：附335例报告

目的：探讨合并门静脉癌栓（PVTT）的肝癌手术治疗的指征与价值。方法：回顾性分析335例伴PVTT肝癌患者临床病理及随访资料，其中273例行手术治疗，包括规则性或非规则性肝切除术（HR）+PVTT清除术（HR组），62例采用肝动脉化疗栓塞（TACE）治疗（TACE组）。比较两组患者治疗后的生存情况。结果：HR组及TACE组中位生存期分别为4.46个月和5.65个月，差异无统计学意义（P=0.455）；6、12个月生存率分别为30.7%，38.7%与12.1%、19.2%，差异均无统计学意义（均P>0.05）。结论：肝癌合并PVTT不是手术禁忌证，实施HR安全可行，但预后改善不明显，故要遵循个体化标准，慎重选择手术治疗。随着肝癌多学科协作（MDT）治疗及未来精准医学治疗模式的发展，以期能提高其整体治疗水平。

Surgical treatment strategy for primary liver cancer with portal vein tumor thrombus: a report of 335 cases

Objective: To investigate the indication and value of surgical treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods: The clinicopathologic and follow-up data of 335 patients with HCC and PVTT were retrospectively analyzed. Of the patients, 273 cases underwent surgical treatment that included anatomic or non-anatomic liver resection (HR) plus PVTT removal (HR group), and 62 cases were subjected to transcatheter arterial chemoembolization (TACE) treatment (TACE group). The post-treatment survival between the two groups of patients was compared. Results: The median survival time for HR group and TACE group was 4.46 and 5.65 months, respectively, which had no significant difference (P=0.455); the 6- and 12-month survival rate for HR group was 30.7% and 12.1%, for TACE group was 38.7% and 19.2% respectively, which also showed no significant difference (both P>0.05). Conclusion: Concomitant PVTT in HCC is not a surgical contraindication, for which HR is safe and feasible, but offers no obvious survival advantage, so the option of surgical treatment should be considered cautiously according to the individualized assessments. The overall therapeutic effectiveness on this condition can be improved by the development of multi-disciplinary team (MDT) and precise medicine model in HCC treatment.