肝细胞癌伴门脉癌栓两种手术方式的疗效及预后因素  

A retrospective study on two surgical techniques in the treatment of hepatocellular carcinoma with portal vein tumor thrombus and to determine the prognostic factors of overall survival

作　　者：高胜[1] 刘剑勇[1] 张志明[1] 赵荫农[1] 吴飞翔[1] 

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,南宁530021

出　　处：《中华肝胆外科杂志》2014年第10期700-704,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：广西医疗卫生重点科研课题（重200611）;广西科学基金项目（桂科自0728196）;广西科学研究与技术开发计划项目（桂科攻0719006-2-5.）;广西科学研究与技术开发计划攻关项目（桂科攻1355005-3-3）

摘　　要：目的 探讨肝细胞癌（HCC）伴门脉癌栓（PVTT）两种手术方式的疗效及预后因素.方法 回顾性分析1995年1月至2010年12月广西医科大学附属肿瘤医院手术切除治疗的143例HCC伴Ⅰ或Ⅱ型癌栓患者的临床资料.根据门脉癌栓的不同处理方式将患者分为两组,A组1 15例,采用肝癌联合门脉癌栓切除;B组28例,采用肝癌切除联合门脉切开取栓或肝创面取栓.结果 A组患者中位生存时间为18.0个月,1、2、3年生存率分别为60.6％、41.0％、25.6％;B组患者的中位生存时间为7.0个月,1、2、3年生存率分别为35.1％、13.6％、9.1％,差异有统计学意义（P＜0.001）.单因素分析显示肿瘤个数、癌栓类型、术后预防性肝动脉化疗栓塞（TACE）、癌栓处理方式为患者预后的影响因素（P＜0.05）.多因素分析表明术后预防性TACE、癌栓处理方式为影响患者预后的独立因素.结论 肝癌联合门脉癌栓切除患者的长期生存时间优于肝癌切除联合门脉切开取栓或肝创面取栓,术后辅以预防性TACE治疗,可以进一步改善HCC伴PVTT患者的预后.Objective To study the impact of two surgical techniques in the treatment of hepatocellular carcinoma （HCC） with portal vein tumor thrombus （PVTT）.Methods A retrospective study was conducted on 143 patients with HCC with PVTT who underwent hepatectomy from January 1995 to December 2010 at the Affiliated Tumor Hospital of Guangxi Medical University.The patients were divided into two groups：group A,115 patients who underwent resection of HCC with PVTT; group B,28 patients who underwent HCC resection but the PVTT was extracted from the cut opening of the portal vein or the transected liver parenchyma.Results The median overall survival of group A was 18.0 months and the cumulative 1-,2-,3-year survival rates were 60.6％,41.0％,25.6 ％,respectively; the median overall survival of group B was 7.0 months and the cumulative 1-,2-,3-year survival rates were 35.1％,13.6％,9.1％,respectively.The differences between the 2 groups were statistically significant （P ＜ 0.001）.Univariate analysis showed tumor number,PVTT types,prophylactic transcatheter arterial chemoembolization （TACE）,and surgical technique to be significant risk factor of postoperative overall survival （P ＜ 0.05）.Cox multivariate analysis indicated prophylactic TACE and surgical technique to be independent prognostic factor （P ＜ 0.05）.Conclusions When compared with group B patients,group A patients had significantly better overall survival.Postoperative prophylactic TACE further improved survival of these patients.

关 键 词：肝细胞癌 门脉癌栓 肝切除术 预后因素 

分 类 号：R735.7[医药卫生—肿瘤]