手术治疗肝癌伴肝静脉癌栓的疗效分析

Surgical treatment of hepatocellular carcinoma with hepatic vein tumor thrombosis

目的探讨手术治疗肝细胞肝癌(hepatocellular carcinoma,HCC)伴肝静脉癌栓(hepaticvein tumor thrombosis,HVTT)的疗效。方法回顾性分析2011年6月至2017年6月在福建省立医院行手术治疗并确诊为HCC伴HVTT共23例患者的临床病理资料,其中HVTT 14例,下腔静脉癌栓(inferior vena cava tumor thrombosis,IVCTT)9 例。结果 21 例 HCC 伴 HVTT 患者行解剖性肝切除,2例局部切除。HVTT手术时间为(235 ±45)min,IVCTT手术时间为(308 ±75)min。术中出血量分别为(880 ±677)ml、(l 150±808)mlo术后随访时间3 ~44个月。23例患者术后中位无瘤生存时间为5个月,中位生存时间为16个月。 HVTT与IVC1T的中位生存时间分别为14J7个月。23例HVTT/IVCTT患者1、2、3年生存率分别为56. 5%.21. 7%、& 7%。结论肝功能良好、病灶局限可切除、无远处转移的HCC伴HVTT/IVCTT患者,应首选手术治疗。

Objective To evaluate surgical treatment for hepatocellular carcinoma ( HCC ) with hepatic vein tumor thrombus ( HVTT). Methods We retrospectively analyzed the clinical and pathological data of 23 HCC patients with HVTT undergoing surgical treatment at the Department of Hepatobiliary Surgery, Fujian Provincial Hospital from June 2011 to June 2017 , including 14 patients with HVTT and 9 patients with inferior vena cava tumor thrombosis ( IVCTT). Results 21 patients with HVTT underwent anatomical hepatectomy and 2 underwent partial resection. The HVTT operation time was ( 235 ±45 ) min, and the IVCTT operation time was ( 308 ±75) min. The intraoperative blood loss was ( 880 ± 677) ml,( 1 150 ± 808) ml, respectively. The follow-up time after surgery was 3 to 44 months. The median tumor-free survival time of the 23 patients was 5 months, and the median survival time was 16 months. The median survival time of HVTT and IVCTT was 14 months and 17 months, respectively. The 1-, 2-, and 3-year survival rates of the 23 HCC with HVTT/IVCTT were 56.5%, 21.7%, and 8.7%, respectively. Conclusions Surgical treatment is a choice of therapy for HCC patients with HVTT/IVCTT having good liver function, limited and removable lesion, and no distant metastasis.