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目的：研究肝细胞肝癌合并门静脉癌栓患者外科治疗的效果及影响因素。方法：对３１例肝癌合并门静脉主干及其大分支癌栓患者在电凝锐性解剖肝门的基础上，采用肝叶切除加癌栓清除、门静脉主干切开取栓等术式治疗，并对癌栓的临床病理学类型进行探讨。结果：与非治疗者相比，外科治疗明显延长了患者的术后生存期，疗效最好的方法是肝叶切除加取栓术，１８例术后平均存活时间１５个月，门静脉主干切开取栓术次之，８例平均存活８个月。所有取栓成功的患者术后均无食管静脉曲张破裂出血。癌栓的病理类型以增殖型最多见，机化型罕见，但由于癌栓与门静脉壁紧密粘连，不易清除，后者不宜外科治疗。结论：外科治疗有效地防止了肝癌合并门静脉癌栓的严重并发症──急性上消化道出血，并延长、改善了患者的生存期和生命质量。
Objective: To study the effect of surgical treatment of hepatocellular carcinoma combined with portal vein tumor embolus and its influencing factors. Methods: 31 cases of hepatocellular carcinoma combined with portal vein trunk and its large branch of tumor embolus were treated with electrocoagulation and anatomical hilars. Liver lobectomy plus removal of tumor thrombus and main portal vein thrombectomy were used. The clinical pathology of the tumor thrombus was investigated. Results: Compared with non-treatment patients, surgical treatment significantly prolonged the patient’s postoperative survival period. The best method is to perform hepatectomy and thrombectomy. The average survival time is 18 months, and the portal vein trunk incision is performed in 18 cases. The thrombectomy was followed, and 8 patients survived for an average of 8 months. All patients who had successful thrombectomy did not have esophageal variceal bleeding. The pathological type of tumor thrombus is most proliferative type, and the mechanized type is rare. However, due to the close adhesion of the tumor thrombus to the portal vein wall, it is not easy to remove, and the latter is not suitable for surgical treatment. CONCLUSIONS: Surgical treatment effectively prevented severe complications of hepatocellular carcinoma combined with portal vein tumor thrombosis--an acute upper gastrointestinal bleeding--and prolonged and improved the patient’s life span and quality of life.