【摘要】 目的评价原发性肝癌(primary liver cancer,PLC)伴门静脉癌栓(portal vein tumorthrombus,PVTT)外科治疗的方法及疗效。方法采用肝叶切除联合经门静脉癌栓切除或经门静脉残端取栓术治疗PLC合并PVTT13例。其中肉眼癌栓10例,镜下癌栓3例。术后3例仅行门静脉化疗(PVC),3例同时行PVC+肝动脉插管化疗栓塞术(TACE),1例术后单纯行TACE治疗,6例术后未做化疗。结果无手术死亡,肉眼癌栓全部取出。术后10例出现肝功能损害,其中1例于术后28 d死于肝功能衰竭,余经护肝治疗恢复;5例术后出现右侧胸腔积液,予胸腔穿刺抽液后治愈。12例患者均获随访,时间2~60个月。镜下癌栓的3例未复发,非镜下癌栓的9例术后1年内复发6例,行化疗者7例,1年内死亡4例(3例仅行PVC,1例仅行TACE);术后1~2年内复发3例,均为行PVC+TACE者,1~2年内死亡1例。在7例行辅助化疗的患者中,1、2年生存率分别为42.9%(3/7)和28.6%(2/7)。结论外科手术是治疗PLC合并PVTT的有效方法,术后辅以门静脉化疗及TACE能提高疗效。更多还原

【Abstract】 Objective To evaluate the methods and efficacies of the surgical treatment for the primary liver cancer(PLC) with portal vein tumor thrombus(PVTT).Methods There were 10 cases of visible PVTT and 3 cases of microscopic PVTT underwent the hepatic resection combined with the tumor thrombi removal or embolectomy through the portal vein.After operation,there were 3 cases underwent portal vein chemotherapy(PVC) and transcathster heptic artery chemoembolization(TACE),3 cases of PVC only,and 1 case of TACE only.The other 6 cases did not receive the chemotherapy after surgical treatment.Results All the visible PVTTs were removed.One patient died at the 28th day of the liver function failure.All the 12 cases were followed up for 2 to 60 months.No relapse was observed in the microscopic PVTT patients,while in the visible PVTT group,6 relapsed and 4 died(including 3 of PVC only and 1 of TACE only)in the first year,and the other 3 patient of PVC + TACE relapsed and 1 died in the second year.The 1-,and 2-year postoperative survival rate of the 7 chemotherapy cases was 42.9%(3/7) and 28.6%(2/7) respectively.Conclusion Surgical treatment is an effective treatment for hepatocellular carcinoma with PVTT under the condition of appropriate indications.The adjuvant chemotherapy such as PVC and TACE can improve the efficacy of operation.更多还原