肝癌合并门静脉癌栓的治疗对策及疗效比较  

Comparison of the results and therapies for hepatocellular carcinoma with tumor thrombosis in portal vein

作　　者：樊嘉[1] 吴志全[1] 周俭[1] 邱双健[1] 陈荣新[1] 史颖弘[1] 汤钊猷[1] 

机构地区：[1]复旦大学附属中山医院肝癌研究所,上海200032

出　　处：《中华外科杂志》2003年第11期801-804,共4页Chinese Journal of Surgery

基　　金：上海百人计划基金 ( 97BR0 2 9);上海市科技发展基金( 9844 190 67)资助项目

摘　　要：目的　比较肝功能处于代偿期的肝癌合并门静脉癌栓患者不同治疗方法的疗效并探讨影响其疗效的因素。　方法　 138例肝功能处于代偿期、术前估计可以手术切除的门静脉癌栓患者 ,根据不同的治疗方法分成 4组 :保守治疗组 14例、化疗组 4 1例、手术切除组 19例、手术切除加化疗组6 4例。　结果　保守治疗组中位生存时间 3 5个月 ;化疗组中位生存时间 7 1个月 ;手术切除组中位生存时间 10 3个月 ;而手术切除加化疗组中位生存时间 13 4个月 ,术后半年 0 5、1、2、3年生存率分别为 5 3 7%、37 6 %、30 7%、14 0 % ,明显高于其他 3组 (P <0 0 5 )。单因素、多因素分析提示术后化疗次数是影响手术切除后疗效的重要因素。　结论　 (1)门静脉癌栓患者在肝功能处于代偿期 ,术前估计手术能一并切除原发灶与癌栓时 ,应行剖腹探查 ,而手术切除加术后化疗的疗效最好 ;(2 )术后在患者肝功能许可的情况下 ,可行多次栓塞化疗。Objective To compare the clinical effects of different therapies on hepatocellular carcinoma (HCC) with portal vein tumor thrombi (PVTT), and to study the factors that affected the prognosis. Methods One hundred and thirty eight HCC with PVTT patients, whose liver function was compensatory and both tumor and PVTT could probably be resected together as evaluated by preoperative examinations, were divided into four groups: (1) conservative treatment group (n=14); (2)chemotherapy group (n=41); (3)surgical resection group(n=19); (4)surgical resection with postoperative chemotherapy group(n=64). Results The median survival periods in four groups were 3.5, 7.1, 10.1 and 13.4 months, respectively. The half a year-, 1-, 2-, 3-year survival rates in the surgical resection with postoperative chemotherapy group were 53.7%, 37.6%, 30.7% and 14.0%, respectively, which were significantly higher than those of the other three groups (P<0.05). Univariate and multivariate analysis both revealed that the number of chemotherapy courses affected the effect of surgical resection. Conclusions (1) If patients′ liver function is compensatory and tumors with PVTT can be removed together, exploration should be done. Surgical resection followed by postoperative chemotherapy would produce the best clinical result. (2) If patients′ liver function is permissible, multiple chemotherapeutic courses should be given after resection of HCC with PVTT.

关 键 词：肝癌 门静脉癌栓 治疗 疗效比较 并发症 

分 类 号：R735.7[医药卫生—肿瘤]