不同方法治疗肝癌合并门静脉癌栓的疗效比较

Comparison of curative effect for hepatocellular carcinoma with tumor thrombosis in ported vein

目的比较肝功能处于代偿期的肝癌合并门静脉癌栓患者不同治疗方法的疗效并探讨影响其疗效的因素。方法50例肝癌合并门静脉癌栓患者,根据不同的治疗方法分为四组：保守治疗组12例、化疗组12例、手术切除组13例、手术切除加化疗组13例。结果保守治疗组中位生存时间3．5个月；化疗组中位生存时间7．1个月；手术切除组中位生存时间10．3个月；而手术切除加化疗组中位生存时间13．4个月,术后0．5、1、2、3年生存率分别为53．7%、37．6%、30．7%、14．0%,明显高于其他三组(P＜0．05)。单因素、多因素分析提示术后化疗次数是影响手术切除后疗效的重要因素。结论门静脉癌栓患者手术切除加术后化疗的疗效最好。

Objective To compare the clinical effect of different therapies on hepatocellular carcinoma（HCC） with ported vein tumor thrombi（PVIT） ,and to study the factors that affected the prognosis. Methods 50 cases of HCC with PVTT,whose liver function was compensatory and both tumor and PVTT could probably be resected together as evaluated by preoperative examinations, were divided into four groups： （1）Conservative treatment group（ n = 12 ） ; （2） Chemo-therapy group （ n = 12 ） ; （ 3 ） Surgical resection group （ n = 13 ） ; （ 4 ） Surgical resection wit h postoperative chemotherapy group（ n = 13）. Results The median survival periods in four groups were 3.5,7.1,10.3 and 13.4 months, respect-tively. The 0. 5, 1,2, 3-year survival rates in the surgical resection with postoperative chemotherapy group were 53.7 % , 37.6 %, 30.7 96 and 14.0 %, respec-tively; Which were significantly higher than those of the other three groups（P 〈 0.05 ）. Both univariate and multivariate analysis revealed that the number of chemotherapy courses affected the effect of surgical resection. Conclusion If patients＇ liver function is compensatory and tumors with PVTT can be removed together, exploration should be done. Surgical resection followed by postoperative chemotherapy would produce the best clinical result.