肝癌术中断端门静脉途径置管术后化疗的临床观察

To observe the effect of implanting tube into breakpoint of portal vein for chemotherapy in hepatectomy for hepaticellula carcinoma with portal vein tumor thrombi.

目的探讨肝癌合并门脉癌栓切除术中从门静脉断面途径直接埋管化疗治疗肝癌的临床疗效及应用价值。方法总结笔者所在科室46例原发性肝癌并门静脉癌栓手术切除病例，22例患者术中直接从门静脉断端埋管术后化疗（A组）；24例患者常规行胃网膜右静脉置管术后化疗（B组）；46例均获得随访。结果A组6个月、12个月生存率分别为：90．9％（20／22）、59．1％（13／24）与B组87．5％（21／24）、58．3％（14／24）比较，差异无统计学意义（P〉0．05）。A组术后出现上消化道出血等并发症1例4．5％，13组6例25．0％，两者差异有统计学意义（P〈0．05）。结论原发性肝癌术中经断面门静脉支途径直接置管术后化疗不增加手术创伤和难度，且并发症少，疗效与传统胃网膜右静脉置管化疗疗效相近，值得临床推广。

Objective To evaluate the clinical efficacy and practical value of implanting tube into breakpoint of portal vein for chemotherapy in hepatectomy for hepatieellula carcinoma with portal vein tumor thrombi. Methods the clinical data of 46 cases of HCC performed hepatectomy with removal of portal vein tumor thrombi were analyzed. All the cases were divided into ：2 groups. 22 cases of A group implanted tube into breakpoint of portal vein directly, and the other 24cases of B group implanted tube into right gastroepiploic vein by convention, all of the 46 eases had been followed up. Results Survival rate of 6 and 12 months in A group was 90.9% （20/22） , and 59.1% , respectively,the survival rate of 6 and 12 months in B group was 87.5% （21/24 ）and 58.3 % （12/24） , there＇s no significant difference of survival rate exist between the two groups（P 〉0.05）. the postoperative complication occurred in 1 case of upper GI bleeding of A group（4.5% ） ,and in 6 cases of upper GI bleeding of B group,the significant difference exist between the two groups（P 〈 0.05）. Conclusion Without more surgical injury and technical difficulty added, Less postoperative complication happened, the similar clinical efficacy as implanting tube into right gastroepiploic vein） , it is valuable to extend on clinical practice.