门静脉癌栓分型对肝癌手术远期预后的影响  

Effects of type of PVTT on long-term outcomes of surgical treatment for hepatocellular carcinoma

作　　者：孟海鹏[1] 牛卫博[1] 吴小鹏[1] 郭森[1] 刘毅[1] 陈雨信[1] 

机构地区：[1]山东大学齐鲁医院肝胆外科,济南250012

出　　处：《山东大学学报（医学版）》2013年第12期61-66,共6页Journal of Shandong University:Health Sciences

摘　　要：目的探讨门静脉癌栓(PVTT)的部位与程度对肝癌手术疗效的影响。方法回顾性分析山东大学齐鲁医院普外科2010年1月至2012年12月203例行肝部分切除伴或不伴门静脉切开取栓术的原发性肝癌合并门静脉癌栓患者的临床资料,对其临床特征、复发及生存情况进行分析。结果 203例患者的并发症率和住院死亡率分别为30.0%和0.5%,中位随访期6.5个月。1年和3年生存率分别为33.5%和12.8%,1年和3年无病生存率分别为10.8%和3.0%。合并VP1(PVTT局限于门静脉二级分支以远)、VP2(PVTT侵犯门静脉二级分支)、VP3(PVTT侵犯门静脉一级分支)型PVTT患者的生存率显著高于合并VP4(PVTT累及门静脉主干或对侧一级分支)型PVTT的患者。结论对于合并VP1、VP2、VP3型PVTT的肝癌患者,手术是合理的选择。而对于PVTT累及门静脉主干(VP4)的肝癌患者,手术仍有争议,待进一步研究。Objective To evaluate effects of location and extent of PVTT on long-term outcomes of surgical treatment for hepatocellular carcinoma（HCC）. Methods A retrospective study was carried out on patients who underwent partial hepatectomy with or without portal thrombectomy for HCC with PVTT in Qilu Hospital of Shandong University from January 2010 to December 2012. The patients＇ clinical characteristics, recurrence and survival were analyzed. Results A total of 203 patients with HCC and portal vein tumor thrombus （PVTT） who underwent partial hepatectomy were studied. The complication rate and hospital mortality rate were respective 30.0% and 0.5%, and median follow-up was 6.5 months. The 1- and 3-year overall survival rates were 33.5% and 12.8%, respectively. The 1- and 3-year disease- free survival rates were 10.8% and 3.0%, respectively. Patients with VP1 ,VP2 and VP3 showed significantly better survival than those with VP4. Conclusion Liver resection is justified in selected patients with VP1, VP2 and VP3. However, surgical resection for PVTT involving the main trunk （VP4） is still controversial.

关 键 词：肝细胞癌 门静脉癌栓 门静脉 外科治疗 

分 类 号：R735.7[医药卫生—肿瘤]