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目的评价原发性肝癌(primary liver cancer,PLC)伴门静脉癌栓(portal vein tumorthrombus,PVTT)外科治疗的方法及疗效。方法采用肝叶切除联合经门静脉癌栓切除或经门静脉残端取栓术治疗PLC合并PVTT13例。其中肉眼癌栓10例,镜下癌栓3例。术后3例仅行门静脉化疗(PVC),3例同时行PVC+肝动脉插管化疗栓塞术(TACE),1例术后单纯行TACE治疗,6例术后未做化疗。结果无手术死亡,肉眼癌栓全部取出。术后10例出现肝功能损害,其中1例于术后28 d死于肝功能衰竭,余经护肝治疗恢复;5例术后出现右侧胸腔积液,予胸腔穿刺抽液后治愈。12例患者均获随访,时间2~60个月。镜下癌栓的3例未复发,非镜下癌栓的9例术后1年内复发6例,行化疗者7例,1年内死亡4例(3例仅行PVC,1例仅行TACE);术后1~2年内复发3例,均为行PVC+TACE者,1~2年内死亡1例。在7例行辅助化疗的患者中,1、2年生存率分别为42.9%(3/7)和28.6%(2/7)。结论外科手术是治疗PLC合并PVTT的有效方法,术后辅以门静脉化疗及TACE能提高疗效。
Objective To evaluate the surgical treatment and efficacy of primary liver cancer (PLC) with portal vein tumorthrombus (PVTT). Methods Thirteen cases of PLC combined with PVTT were treated with hepatectomy combined with portal vein tumor thrombus resection or portal vein stump thrombectomy. Among them, 10 cases were macroscopic and ocular embolism, and 3 cases were tumor embolism. Three patients underwent portal vein chemotherapy (PVC) after operation. Three patients underwent TACE with PTCA and PTCA at the same time. One patient underwent TACE after operation and 6 patients underwent chemotherapy. The results of non-surgical death, all the cancerous emboli removed. One case of liver dysfunction died after 28 days of operation, and the other cases recovered after protection of liver. Five cases had right pleural effusion after operation and were cured after thoracentesis and fluid extraction. All 12 patients were followed up for 2 ~ 60 months. Among the 3 cases of non-recurrent and non-microscopic tumor thrombus, 9 cases recurred 6 cases within 1 year after surgery, 7 cases underwent chemotherapy and 4 cases died within 1 year (3 cases only PVC and 1 case TACE only) ; 3 cases recurred within 1 to 2 years after operation, all of whom underwent PVC + TACE, and 1 died within 1 to 2 years. Among 7 patients who received adjuvant chemotherapy, the 1- and 2-year survival rates were 42.9% (3/7) and 28.6% (2/7), respectively. Conclusion Surgery is an effective treatment for PLC combined with PVTT. Postoperative adjuvant chemotherapy with portal vein and TACE can improve the curative effect.