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目的:探讨合并门静脉癌栓(PVTT)的肝癌手术治疗的指征与价值。方法:回顾性分析335例伴PVTT肝癌患者临床病理及随访资料,其中273例行手术治疗,包括规则性或非规则性肝切除术(HR)+PVTT清除术(HR组),62例采用肝动脉化疗栓塞(TACE)治疗(TACE组)。比较两组患者治疗后的生存情况。结果:HR组及TACE组中位生存期分别为4.46个月和5.65个月,差异无统计学意义(P=0.455);6、12个月生存率分别为30.7%,38.7%与12.1%、19.2%,差异均无统计学意义(均P>0.05)。结论:肝癌合并PVTT不是手术禁忌证,实施HR安全可行,但预后改善不明显,故要遵循个体化标准,慎重选择手术治疗。随着肝癌多学科协作(MDT)治疗及未来精准医学治疗模式的发展,以期能提高其整体治疗水平。
Objective: To investigate the indications and values of surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus (PVTT). Methods: A retrospective analysis of 335 patients with PVTT in patients with histopathological and follow-up data, of which 273 patients underwent surgical treatment, including regular or irregular hepatectomy (HR) + PVTT removal (HR group), 62 patients with liver Arterial Chemoembolization (TACE) Treatment (TACE Group). The survival of the two groups after treatment was compared. Results: The median survival time in HR group and TACE group was 4.46 months and 5.65 months respectively, with no significant difference (P = 0.455). The survival rates at 6 and 12 months were 30.7%, 38.7% and 12.1% respectively, 19.2%, the differences were not statistically significant (all P> 0.05). Conclusion: The combination of PVTT and hepatocellular carcinoma is not a contraindication for surgery. It is safe and feasible to implement HR, but the improvement of prognosis is not obvious. Therefore, it is necessary to follow individualized criteria and choose surgical treatment carefully. With the multidisciplinary cooperation in liver cancer (MDT) treatment and the future development of accurate medical treatment model, with a view to improve its overall level of treatment.