原发性肝癌合并门静脉癌栓的外科治疗方式选择

Treatment and surgery of primary hepatic cancer with portal vengus tumor thrombosis

目的 探讨原发性肝癌(HCC)合并门静脉癌栓(TTPV)的外科治疗方式选择。方法对1990年1月至2003年1月期间收治的138例肝癌合并门静脉癌栓患者的临床资料进行分析和总结。结果 37例行保守姑息治疗患者1至8个月内死亡,平均生存时间3 9个月。101例患者行手术治疗,其中23例行单纯肝癌切除术,平均生存时间10 9个月; 78例采取各种手术方式行肝癌切除加门静脉癌栓取栓术,平均生存时间26 8个月。其中52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96 2%、51 .9%、11 .5%, 26例未行插管化疗, 1、3、5年生存率为76 .9%、23 .1%、0%。结论 手术治疗比保守治疗能相对延长肝癌合并门静脉癌栓患者的生存时间;手术在切除肝癌的同时应尽量使用各种方式取出门静脉癌栓;术后使用肝动脉和门静脉双插管微量泵灌注化疗可有效提高治疗效果。

Objective To study the methods of surgery for hepatocellular carcinoma (HCC) with tumor thrombi in portal vein(TTPV). Methods To Analyze and summerize the clinical information from 138 HCC patients with tumor thrombi in portal vein collected during January 1990 and January 2003. Results Thirty-seven patients receiving palliative therapy died from 1 to 8 months, and average survival time is 3.9 months. 101 patients had operation treatment, 23 of them underwent hepatoma resection, and average survival time was 10.9 months; 78 patients underwent hepatoma resection and removal of tumor thrombi, and average survival time was 26.8 months. 52 of whom underwent hepatic artery and portal vein chemoembolization, the 1-, 3-, 5-yeared survival rates was 96.2% ,51.9%,11.5%,the 1-,3-,5-yeared survival rates of the 26 patients who didn′t undergo chemoembolization were 76.9%,23.1%,0%. Conclusions Operation treatment can comparatively extend the survival time of hepatocellular carcinoma with tumor thrombi in portal vein patients, and the best choice is hepatoma resection and removal of tumor thrombi , hepatic artery and portal vein chemoembolization after operation can enhance the effect.