肝癌伴门静脉癌栓形成与食管胃底静脉曲张程度及出血的关系

The relationship between gastroesophageal varices and bleeding and portal venous tumor thrombi in patients with hepatocellular carcinoma

目的探讨肝癌伴门静脉癌栓形成与食管胃底静脉曲张程度及出血的关系。方法根据Ⅰ～Ⅳ癌栓分型标准将 84例肝癌伴门静脉癌栓患者分为Ⅰ～Ⅳ组 ,回顾分析各组患者的食管胃底静脉曲张程度、生存期和死亡原因。结果Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组患者食管胃底静脉曲张为轻度者分别为 6 5 %、76 %、86 %、10 0 % ,重度者均在 5 %以下。各组中位生存期分别为 10 1、7 2、5 7、3 0个月。各组患者死亡原因为上消化道出血和肝功能衰竭各占 5 0 %。结论门静脉癌栓并不是引起肝癌食管胃底静脉曲张及出血的主要原因。

Objective To study the relationship between gastroesophageal varices and bleeding and portal venous tumor thrombi in patients with hepatocellular carcinoma(HCC). Methods From Jan. 2000 to Jan. 2003, 84 HCC patients with portal vein tumor thrombi were divided into Ⅰ～Ⅳ groups according to Ⅰ～Ⅳ types of tumor thrombi. The grade of gastroesophageal varices, the median survival time and the death cause for group Ⅰ～Ⅳ were retrospectively analyzed. Results Mild grade of gastroesophageal varices accounted for 64.7%, 6.0%, 85.7%,100%, respectively in group Ⅰ(n=17), Ⅱ(n=26),Ⅲ( n=35) and group Ⅳ(n=6),respectively. Severe varices were found in less than 5% in all four groups. The median survival periods were 10.1, 7.2, 5.7 and 3.0 months, respectively (P=0.0001). Most cases died from esophageal and gastric variceal bleeding and hepatic failure, with each accounting for about 50% of the mortality in all the 4 groups. Conclusions Portal venous tumor thrombi of HCC patients was not the major cause leading to esophageal and gastric varices and bleeding.