肝癌合并门静脉癌栓手术疗效及预后分析

Surgical effectiveness and prognosis of hepatocellular carcinoma with portal vein tumor thrombus

目的探讨影响肝癌合并门静脉癌栓病人手术疗效和预后的因素.方法回顾性分析我院2000年～2003年收治的68例肝癌合并门静脉癌栓病人的临床资料.分别按术后是否加用化疗、有无合并肝硬变、肿瘤大小及Child-Pugh分级等进行分组研究,比较各组间术后不同的疗效.结果手术切除加化疗组中位生存时间为17.8月,术后6个月及1、2、3年生存率分别为80.4%及64.7%、47.1%、31.4%;单纯手术切除组分别为14.5月和70.6%、52.4%、29.4%、5.9%.手术切除加化疗组疗效均明显优于单纯手术切除组(P＜0.05).结论手术切除加术后化疗或栓塞治疗是治疗肝癌合并门静脉癌栓病人的有效治疗方案.肝硬变、肿瘤大小及Child-Pug分级与病人术后生存时间相关,可作为判断预后的重要指标.

Objective To study the factors influencing the prognosis and surgical effectiveness of hepatoeellular carcinoma（HCC）with portal vein tumor thrombus （PVTT）. Methods The clinical data of 68 cases of HCC with PVTT from 2001 to 2004 were analyzed retrospectively. All patients were subjected to surgical operation. In terms of postoperative chemotherapy, liver cirrhosis and tumor size,Child-Pugh stage, the cases were divided two groups and analyzed respectively. Results In the group of surgical resection plus postoperative chemotherapy, the median survival time was 17. 8 months and the postoperative 0. 5-, 1-,2-,3-year survival rates were 80. 4% ,64. 7% ,47. 1% and 31.4% respectively. In the group of simple surgical resection, the median survival time was 14. 5 months,and the postoperative 0. 5-, 1-, 2-, 3-year survival rates were 70. 6 %, 52. 4 %, 29. 4 % and 5. 9 % respectively. There were significant difference between the two groups（P〈0. 05）. Conclusion Surgical resection combined with postoperative chemotherapy or chemoembolization is an effective therapy for the HCC with PVTT; Liver cirrhosis, tumor size and Child-Pugh stage may be important parameters to estimate the prognosis of HCC with PVTT.