原发性肝癌合并门静脉癌栓术后双路介入治疗的效果评价

The comparative study of two kinds of treatment mode of post-operation with portal vein tumor thrombus in primary hepatocellular carcinoma patients

目的评价可手术切除的原发性肝癌(primary hepatocellular carcinoma,PHC)合并门静脉癌栓(portal vein tumor thrombus,PVTT)患者仅行肝动脉化疗栓塞(transcatheter arterial chemo-embolization,TACE)和经皮肝穿刺门静脉化疗(percutaneous transhepatic portal vein chemotherapy,PVC)联合TACE的治疗效果。方法选择可手术切除的PHC合并PVTT患者36例,随机分成A、B两组,A组患者术后1个月肝功能基本正常后行TACE;B组患者术后1个月肝功能基本正常后行PVC,术后2个月肝功能基本正常后行TACE,对比两组患者的治疗效果和生存情况。结果 A组患者中位生存期13个月;B组患者中位生存期17个月。A组患者1年、2年、3年生存率分别为50.0%、22.2%、11.1%;B组患者1年、2年、3年生存率分别为77.8%、44.4%、33.3%,两组间生存率比较有显著性差异(P<0.05)。结论合并PVTT的PHC患者手术切除后经双路(PVC+TACE)介入治疗比单纯TACE治疗更能提高治疗效果,延长患者生存时间。

Objective To evaluate treatment effects of different treatment patterns after operation in primary hepatoeellular carcinoma （PHC） patients with portal vein tumor thrombus（PVTT）, to explore the better mode of treatment after operation in PHC patients with PVTT. Methods 36 PHC patients with PVTF which could be excised were randomly divided into group A and group B. Group A patients in normal liver function month after post-operation was treated by transcatheter arterial chemoembolization （TACE） , group B patients in normal liver function month after post-operation was treated by percutaneous trans-hepatic portal vein chemotherapy （PVC） , and patients in normal liver function two months after post-operation was treated by TACE. Therapeutic effect and survival rate were compared between 2 groups. Results The median smvival time was 13 months in A group of patients; the median survival time was 17 months in B patients. A group of patients for 1-year, 2-year,3-year survival rates were 50% , 22.2% , 11.1% ; B group of patients for 1-year, 2-year, 3 year survival rates were 77.8% , 44.4%, 33.3% , two group survival rate had significant difference （ P 〈 0.05 ）. Conclusions PHC patients with PVTY after operation treated with dual interventional therapy （TACE ＋ PVC） can get the more treatment effect than simple TACE treatment, and can prolong the survival time of patients.