原发性肝细胞癌合并门静脉癌栓的外科治疗

THE SURGICAL TREATMENT OF PRIMARY HEPOTACELLULAR CARCINOMA WITH TUMOR THROMBI IN PORTAL VEIN

目的探讨原发性肝细胞癌合并门静脉癌栓的外科治疗方法。方法采用肝叶切除及经门静脉残端或主干切开取癌栓治疗32例PHCC合并PVTT,12例术后联合门静脉、肝动脉介入化疗,对其临床资料进行总结分析。结果1、本组病例术中出血量、输血量、肝门阻断次数时间、并发生率、手术死亡率与同期50例无癌栓肝癌切除组比较无显著性差异(P>0.05)。2、随访26例,术后复发时间为2m^28m,术后是否化疗对复发时间有显著影响;1、2、3年生存率分别为46.2%、38.5%、15.4%;术后化疗、术前肝功能状况对生存期有显著影响。结论肝叶切除+经门静脉断端或/和主干切开取癌栓是治疗肝癌合并门静脉癌栓最有效的方法,改善术前肝功能及术后联合化疗对延缓复发、提高生存率意义重大;对于难以切除的PHCC合并PVTT应争取行TACE术,仍有二期手术切除的机会。

Objective To study the effective methods of the treatment for heptocellular carcinoma（HCC） with portal vein tumor thrombi （PVTT）. Methods 32 HCC with PVTT patients underwent hepatic resection and removal of tumor thrombi, 12 cases among it underwent portal vein and heptic artery chemoembolization. The clinic materials were summarized. Result 1. The amount of bleeding, intraoperative blood transfusion, frequency and time of porta hepatic interception,complication incidents,mortality were not significantly different between this group and that 50 HCC patients without PVTT undergoing operation. 2.26 cases were follow-up survey. The postoperative recurrence time of tumor were 2-28m,which was significantly relevant to postoperative chemoembolization ; the 1-, 2-, 3-year survival rate were 46.2 %. 38.5%-15.4% ; which was significantly relevant to the postoperative chemoembolization and preoperative liver function condition. Conclusion Hepatic resection and removal of tumor thrombi from portal vein were more effective methods for HCC with PVTT;improving preoperative liver function and combining portal vein and hepatic artery chemoembolization were very important for the prolongation of life;to those patients which could not take the hepatic section,TACE should be done as possible,there were also chance to have the secondary operation.