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目的探讨肝功能代偿期手术切除或TACE治疗肝细胞肝癌(HCC)合并门静脉主支癌栓的疗效,以及TACE后选择性肝切除术的安全性。方法选择肝功能Child-PughA可切除的原发性肝癌并门脉主支癌栓患者116例,并分为手术组(56例)和肝动脉化疗栓塞组(TACE组,60例),其中TACE组治疗后肿瘤反应评价有效,接受进一步手术治疗的患者纳入TACE+手术组。对比3组患者的治疗效果和生存情况。结果手术组1例术中死亡(1/56,1.78%),并发症发生率高于TACE组(16/56vs7/60,P=0.010)。手术组、TACE组和TACE+手术组的中位生存时间为11.41、15.34、22.01个月,TACE+手术组的生存时间明显长于手术组(P=0.040)。手术组1、2、5年生存率分别为47.27%、24.58%、5.67%;TACE组分别为53.91%、27.18%、6.34%;TACE+手术组分别为79.17%、45.83%、16.67%。多因素分析提示肝硬化、肿瘤位置是患者独立预后相关因素。结论 HCC合并门静脉主支癌栓肝功能代偿良好可切除者,首治TACE后选择性肝切除术是更安全和有效的治疗策略。
Objective To investigate the efficacy of hepatectomy or TACE in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis and the safety of selective hepatectomy after TACE. Methods One hundred and sixty-six patients with primary hepatic carcinoma resected with Child-PughA resected primary liver cancer and portal vein thrombosis were selected and divided into operation group (56 cases) and hepatic arterial chemoembolization group (TACE group, 60 cases). TACE Tumor response was evaluated after treatment, and patients undergoing further surgery were included in TACE + surgery group. Comparison of 3 groups of patients with treatment and survival. Results One patient died in the operation group (1/56, 1.78%), and the complication rate was higher than that in the TACE group (16/56 vs 77/60, P = 0.010). The median survival time of operation group, TACE group and TACE + operation group was 11.41,15.34,22.01 months, and the survival time of TACE + operation group was significantly longer than that of operation group (P = 0.040). The 1-, 2-, and 5-year survival rates of the surgery group were 47.27%, 24.58% and 5.67% respectively, while those of the TACE group were 53.91%, 27.18% and 6.34% respectively. The TACE group was 79.17%, 45.83% and 16.67% respectively. Multivariate analysis showed that cirrhosis and tumor location were independent prognostic factors in patients. Conclusions HCC with portal vein tumor thrombus in well-compensated hepatic resection can be resected, after the first rule of TACE after selective hepatectomy is a safer and more effective treatment strategy.