肝癌合并门静脉癌栓的诊疗新视角  

New perspective of diagnosis and treatment of hepatocellular carcinoma complicated with portal vein tumor thrombosis

作　　者：彭淑牖[1] 王一航 金赟[1] 李江涛[1] Peng Shuyou;Wang Yihang;Jin Yun;Li Jiangtao(Department of Hepatobiliary-Pancreatic Surgery,Second Affiliated Hospital,Zhejiang University College of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院肝胆胰外科,杭州310009

出　　处：《中华外科杂志》2025年第2期102-106,共5页Chinese Journal of Surgery

基　　金：浙江省重点研发计划项目(2024C03172)。

摘　　要：肝细胞癌(HCC)是最常见的肝脏恶性肿瘤, 常合并门静脉癌栓(PVTT)。PVTT与HCC患者的不良预后相关, 治疗效果仍不尽如人意。随着对PVTT病理机制的深入研究, 学界逐渐认识到PVTT与HCC可能源自不同的细胞克隆。已有临床研究提出了多种PVTT分型系统, 这些分型系统为实现个体化、精准化的治疗提供了科学依据。"取栓优先"的手术策略, 旨在降低肿瘤的播散风险, 从而改善患者的预后。此外, 包括靶向治疗、免疫治疗及放疗在内的多学科综合治疗模式, 在PVTT的治疗中展现出了显著的效果。随着PVTT的诊断技术、分型方法及精准治疗策略的持续进步和优化, HCC合并PVTT患者的长期生存率将得到明显提升。Hepatocellular carcinoma(HCC)stands as the predominant type of primary liver cancer,frequently accompanied by portal vein tumor thrombosis(PVTT).PVTT is a harbinger of a grim prognosis,with current treatment modalities falling short of expectations.Delving deeper into the pathophysiology of PVTT,researchers have come to recognize that PVTT and HCC may originate from different clones.Previous clinical investigations have proposed various PVTT classification systems,offering a scientific basis for individualized and precise treatment.The innovative surgical approach of“thrombectomy first”is designed to mitigate the risk of tumor spread,thereby enhancing patient outcomes.Moreover,the multidisciplinary and integrated treatment model,including targeted therapy,immunotherapy and radiotherapy,has demonstrated promising efficacy for the treatment of PVTT.With the continuous progress and optimization of PVTT diagnostic technology,classification systems and precision treatment strategies,the prospects for long-term survival in HCC patients with PVTT are poised to see a significant uplift.

关 键 词：肝肿瘤 肿瘤转移 门静脉癌栓 新分型 取栓优先 

分 类 号：R735.7[医药卫生—肿瘤]