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作者报告了25例肝细胞癌合并门静脉癌栓,于切除肝癌后同时行门静脉癌栓清除术。肝癌位于左侧肝者21例,右侧肝4例。瘤体均较大,直径10.1～20cm者占13例。门静脉主干及左右分支充满癌栓者10例,左右分支分别均有癌栓者3例,癌栓由左支延伸至主干者10例,右前后支同时有癌栓者2例。行左肝叶切除后,自门静脉左支残端清除癌栓较为方便。术后半年、1年和2年生存率分别为95.45%,47.05%和20%。7例未作任何手术,均于3个月内死于食管静脉曲张破裂出血或肝衰。肝癌切除联同门静脉癌栓取出术可有以下优点:①切除原发癌灶,防止癌栓继续侵入门静脉,②可降低门静脉压力,减少食管静脉曲张破裂出血的危险;③使后续治疗如经肝动脉栓塞化疗、免疫等综合治疗得以顺利进行。
The authors reported 25 cases of hepatocellular carcinoma combined with portal vein tumor thrombosis. After removal of hepatocellular carcinoma, he underwent portal vein tumor embolectomy. Liver cancer was located in the left liver in 21 cases and right liver in 4 cases. The tumors were larger, with a diameter of 10.1 to 20cm accounting for 13 cases. There were 10 cases of portal vein and left and right branches full of tumor embolus, 3 cases of left and right branches with cancer thrombus, 10 cases of cancer thrombus extending from left branch to trunk, and 2 cases of cancer thrombus in right anterior and posterior branches. After the left hepatectomy, it is more convenient to remove the tumor thrombus from the left branch of the portal vein. The half-year, 1-year, and 2-year survival rates were 95.45%, 47.05%, and 20%, respectively. Seven patients did not undergo any surgery and all died of esophageal variceal bleeding or hepatic failure within 3 months. The resection of hepatocellular carcinoma combined with portal vein tumor embolectomy can have the following advantages: 1 resection of primary cancer foci to prevent cancer thrombus from continuing to invade the portal vein, 2 reduce portal vein pressure, reduce the risk of esophageal variceal bleeding, 3 enable follow-up treatment such as transhepatic Arterial embolization chemotherapy, immune and other comprehensive treatment took place smoothly.