【摘要】 目的　探讨肝癌合并门静脉癌栓的手术疗效 ,评价术中门静脉癌栓取出术和术后辅助肝动脉栓塞化疗对提高肝癌术后生存率的影响。方法　对 10 6例肝癌合并门静脉癌栓接受不规则性肝叶切除术的病人进行临床分组研究 ,分别采用单纯手术切除 ;手术切除加术中取栓术 ;手术切除、术中取栓术后辅助肝动脉栓塞化疗 ,比较各组的疗效。结果　全组病人的 1,3和 5年生存率分别为36 1% ,2 4 7%和 2 4 7%。单纯手术切除组 ( 5 1例 )的 1、3和 5年生存率分别为 2 0 .9% ,13.9%和13 9% ;手术切除加术中取栓术 ( 30例 )的 1,3和 5年生存率分别为 46 .7% ,2 8.0 %和 2 8.0 % ;术中取栓术后辅助肝动脉栓塞化疗 ( 2 5例 )的 1,3和 5年生存率分别为 48.0 % ,37.4%和 37.4% (P =0 .0 4)。术后出现消化道出血 5例 ,4例为非取栓组 ,其中 1例因消化道大出血死亡。结论　取栓术和术后肝动脉栓塞化疗可提高肝癌合并门静脉癌栓的手术疗效 ,取栓术还可能降低门静脉压 ,减少消化道大出血的发生率。更多还原

【Abstract】 Objective To explore the value of removing portal vein tumor thrombus (PVTT) and TACE in improving the outcome of resection for primary liver cancer with PVTT. Methods A prospective study on therapeutic effects of irregular lobe resection on liver cancer with PVTT was conducted in 106 cases. Fifty one patients underwent lobe resection alone (group A), 30 received lobe resection and removal of PVTT (group B) and the other 25 received TACE after lobe resection and removal of PVTT (group C). Results For all the patients, the 1-, 3- and 5-year survival rates were 36.1%, 24.7% and 24.7%, respectively. They were respectively 20 9%, 13 9% and 13 9% in group A, 46 7%, 28 0% and 28 0% in group B and 48 0%, 37 4% and 37 4% in group C (P=0.04). Hemorrhage of digestive tract occurred in 5 cases after operation. Of the 5 cases, 4 belonged to group A and 1 died. Conclusions TACE after lobe resection and removal of PVTT can improve the outcome of resection for primary cancer with PVTT. Removal of PVTT might decrease portal pressure to reduce occurring rate of hemorrhage of digestive tract.更多还原