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目的研究手术切除联合门静脉免疫化疗对原发性肝癌(HCC)合并门静脉癌栓(PVTT)患者的临床疗效的影响。方法将2001年1月至2005年12月收治的76例原发性肝癌合并门静脉主干和(或)一级分支癌栓患者分为两组,A 组(n=29)行肿瘤切除加癌栓取出术,术后经门静脉行免疫化疗(5-氟尿嘧啶、阿霉素、顺铂、干扰素-α);B 组(n=47)仅行手术切除加癌栓取出术。比较两组患者生存率并对预后影响凶素进行分析。结果 A、B 两组6个月,1、2、3年牛存率分别为82.3%和52.7%,46.5%和20.2%,14.3%和5.8%,14.3%和5.8%,中位生存时间分别为11.5和6.0个月(P=0.010),其中无瘤生存分别为4.5和2.4个月(P=0.032)。多因素回归分析显示,影响总生存期的因素包括化疗、病理分级和肿瘤大小。影响无瘤生存期的因素包括化疗和病理分级。结论 HCC 合并 PVTT 患者采取手术切除联合门静脉免疫化疗是有效的。
Objective To investigate the effect of surgical resection combined with portal vein immunotherapy on the clinical efficacy of primary hepatic carcinoma (HCC) combined with portal vein tumor thrombus (PVTT). Methods 76 primary hepatocellular carcinoma patients with primary portal vein tumor and / or primary tumor thrombus admitted in our hospital from January 2001 to December 2005 were divided into two groups. Group A (n = 29) underwent tumor resection plus tumor thrombus (5-Fluorouracil, doxorubicin, cisplatin and interferon-α) were given through the portal vein after operation. The patients in group B (n = 47) underwent resection and tumor embolization only. The survival rates of two groups were compared and the prognostic factors were analyzed. Results The 6-month, 1-year, 2-year and 3-year survival rates of group A and B were 82.3% and 52.7%, 46.5% and 20.2%, 14.3% and 5.8%, 14.3% and 5.8% respectively. The median survival time For 11.5 and 6.0 months (P = 0.010), with no-tumor-free survival of 4.5 and 2.4 months, respectively (P = 0.032). Multivariate regression analysis showed that the factors affecting the overall survival include chemotherapy, pathological grade and tumor size. Factors that influence disease-free survival include chemotherapy and pathological grading. Conclusion HCC with PVTT patients with surgical resection combined with portal vein immunochemotherapy is effective.