肝癌合并门静脉癌栓术后门静脉化疗疗效分析

The efficacy of portal vein chemotherapy on patients with liver cancer complicated with portal vein tumor thrombus undergoing hepatectomy

目的肝癌合并门静脉癌栓手术切除后,对门静脉化疗疗效进行评估和分析。方法回顾性分析45例合并门静脉癌栓的肝癌病例资料,根据术后治疗情况分为门静脉化疗组(A组)27例,采用手术切除之后辅以门静脉化疗术(PVC)+肝动脉化疗栓塞术(TACE)+微波固化治疗术(PMCT);非门静脉化疗组(B组)18例,采用TACE+PMCT治疗,比较两组疗效及并发症情况。结果围手术期无死亡病例,病理检查均提示为肝细胞癌,45例患者中36例在后期死于肝癌复发转移。两组之间生存率有统计学差异(χ2=3.988 P=0.046)。A组1、3、5年生存率分别是76.0%、40.0%、20.0%,B组分别是55.6%、16.7%、5.6%。术后共实施PMCT39次,TACE136次,比较两组中位数分别为1,1;3,3;平均秩分别为22.52,23.72;20.74,26.39;P分别为0.748,0.141)。结论对可切除的肝癌合并门静脉癌栓实施肝切除术为主,术后辅以PVC+TACE+PMCT疗效更好。

Objective To evaluate the efficacy of portal vein chemotherapy in patients with liver cancer complicated with portal vein tumor thrombus（PVTT）underwent hepatectomy.Methods Data of 45 cases were retrospectively studied,which were divided into Group PVC and Group Non-PVC according to postoperative further diverse managements.Group PVC（27cases）accepted portal vein chemotherapy（PVC）＋transcatheter arterial chemoembolization（TACE）＋percutaneous microwave coagulation therapy（PMCT）.Group Non-PVC（18cases）was treated with TACE ＋PMCT.Results All cases were hepatocellular carcinoma（HCC）confirmed by pathological examination without mortality during peri-operation.36 cases died of recurrence and metastasis of HCC forward.There was statistical significance in cumulative survival rate of the two groups（χ2=3.988;P=0.046）.1y,3y and 5y survival was 76.0%,40.0% and 20.0%in Group PVC,55.6%,16.7%,5.6% in Group Non-PVC respectively.39 PMCT and 136 TACE of Group PVC and Group Non-PVC were performed after operation.Conclusion PVC＋TACE＋PMCT can get obvious effect on resectable liver cancer complicated with tumor thombi in portal vein after operation.