可切除肝细胞肝癌并门静脉主支癌栓治疗策略的安全性和有效性分析  

Treatment strategies for respectable hepatocellular carcinoma with tumor thrombosis in the major branch of portal vein

作　　者：朱红波[1] 郭荣平[1] 邹如海[2] 罗俊[1] 方成[1] 陈智远[1] 郭智兴[1] 韦玮[1] 石明[1] 

机构地区：[1]华南肿瘤学国家重点实验室,中山大学肿瘤防治中心肝胆科,广州510060 [2]华南肿瘤学国家重点实验室,中山大学肿瘤防治中心超声科,广州510060

出　　处：《中华普通外科学文献（电子版）》2012年第6期35-39,41,共6页Chinese Archives of General Surgery(Electronic Edition)

基　　金："十一五"国家科技重点支撑计划(2006BAI02A04);广东省科技计划项目(2010B031600221);中山大学5010计划(2007043);2009年中山大学青年教师培育项目(09ykpy53)

摘　　要：目的探讨肝功能代偿期手术切除或TACE治疗肝细胞肝癌(HCC)合并门静脉主支癌栓的疗效,以及TACE后选择性肝切除术的安全性。方法选择肝功能Child-PughA可切除的原发性肝癌并门脉主支癌栓患者116例,并分为手术组(56例)和肝动脉化疗栓塞组(TACE组,60例),其中TACE组治疗后肿瘤反应评价有效,接受进一步手术治疗的患者纳入TACE+手术组。对比3组患者的治疗效果和生存情况。结果手术组1例术中死亡(1/56,1.78%),并发症发生率高于TACE组(16/56vs7/60,P=0.010)。手术组、TACE组和TACE+手术组的中位生存时间为11.41、15.34、22.01个月,TACE+手术组的生存时间明显长于手术组(P=0.040)。手术组1、2、5年生存率分别为47.27%、24.58%、5.67%;TACE组分别为53.91%、27.18%、6.34%;TACE+手术组分别为79.17%、45.83%、16.67%。多因素分析提示肝硬化、肿瘤位置是患者独立预后相关因素。结论 HCC合并门静脉主支癌栓肝功能代偿良好可切除者,首治TACE后选择性肝切除术是更安全和有效的治疗策略。Objective To explore the safety and efficacy after two strategies for resectable hepatocellular carcinoma （HCC） with tumor thrombosis （Pvyr） in major branch of portal vein. Methods One hundred and sixteen consecutive resesectable HCC with major branch PVTT and excellent liver reserves （Child-pugh A） patients were enrolled and allocated into two groups. Patients of the operation group （56 cases） received initial hepatic resection. In the TACE group （60 cases）, patients received transarterial chemoembolization as initial treatment, and only patients who showed good response （CR or PR） were subjected to surgical resection, that was TACE ＋ resection group. Results The morbility and mortality were 28.57% （16/56） and 1.78% （1/56） for the operation group and 11.67% （7/60） and 0 （0/60） for the TACE group （P = 0.010）. The median time and 1-, 2-, 5-years were 11.41 months, 47.27%, 24.58%, 5.67% for the operation group. 15.34 months, 53.91%, 17.18%, 6.34% for the TACE group. 22.01 months, 79.17%, 45.83%, 16.67% for the TACE ＋ resection group. There was no significant survival benefits between the operation and TACE group （P = 0.731 ）, while the TACE ＋ resection group showed significant survival benefits compared the operation group （P = 0.040）. Liver cirrhosis and tumor location were independent predicitive factors of a favourable outcome. Conclusion Initial ehemoembolization and selective resection may be a safer and effective treatment stragegy, compared with direct sugrery for compensatory liver function patients with resectable HCC and major branch portal vein invasion.

关 键 词：肝细胞癌 肝切除术 栓塞疗法 门静脉癌栓 并发症 

分 类 号：R735.7[医药卫生—肿瘤]