肝细胞癌伴门静脉癌栓不同治疗方法的比较

目的 比较肝细胞癌合并门静脉癌栓(ｔｕｍｏｒ ｔｈｒｏｍｂｉ ｉｎ ｐｏｒｔａｌ ｖｅｉｎ，ＰＶＴＴ）不同治疗方法的疗效及其意义。方法 １４７例肝细胞癌伴门静脉主干或第１分支癌栓的住院患者，按不同治疗方法分成４组：保守治疗组（Ａ组，１８例）；肝动脉结扎和（或）肝动脉插管化疗组（Ｂ组，１８例），术后定期栓塞化疗；肝癌联同ＰＶＴＴ切除组（Ｃ组，７９例）；手术切除＋肝动脉化疗栓塞和（或）肝动脉置管或门静脉

Comparison of several therapeutic methods for hepatocellular carcinoma with tumor thrombi in portal vein

Objective To compare the therapeutic effect and significance of different treatment methods for hepatocellular carcinoma (HCC) with portal vein tumor thrombi (PVTT).Methods One hundred and forty seven HCC patients with tumor thrombi in the main portal vein or the first branch of portal vein were divided into four groups. A,conservative treatment group ( n =18); B, hepatic artery ligation (HAL) and/or hepatic artery infusion (HAI) group ( n =18), periodically received postoperative chemoembolizations; C, excision of HCC with removal of PVTT group ( n =79); D, transcatheter hepatic arterial chemoembolization or portal vein infusion (PVI) or HAI after operation group ( n =32). Results The median survival period was 2, 5, 12, and 16 months in group A, B, C, D, respectively. Their 1 , 3 and 5 year survival rates was 5.6%, 0 and 0 in group A; 22.2%, 5.6% and 0 in group B; 53.9%, 26.9% and 16.6% in group C; 82.8%, 48.8% and 41.3% in group D, respectively. The survival rates differed significantly between the 4 groups ( P <0.05).Conclusion Resection of cancer with removal of tumor thrombi for HCC with PVTT significantly improves the curative effect and quality of life. Local hepatic chemotherapy or chemoembolization after tumor resection with removal of tumor thrombi may further prolong survival period.