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目的探讨肝癌并门静脉癌栓 (PVTT)患者综合治疗的疗效。方法 5年来共收治176例肝癌合并PVTT的患者 ,手术组 32例 ,行规则或不规则肝切术并术中门静脉取癌栓 ,门静脉或肝动脉置泵术 ;介入组 14 4例 ,经肝动脉栓塞化学药物治疗。结果手术组 0 5 ,1,2年生存率分别为 94 % ,5 0 % ,19% ,术后常见并发症 :暂时性肝功能不全 4 4 % (14 / 32 ) ,右胸腔积液 31% (10 / 32 ) ,上消化道出血 2 8% (9/ 32 )等 ,无手术死亡。介入组 0 5 ,1年生存率为 35 % ,0。在介入组中 ,肝功能分级为Ⅰ的患者 34例在患者年龄 ,癌灶体积大小与手术组无明显差异 ,但其 0 5 ,1年生存率 (5 9% ,0 )显著低于手术组 (94 % ,5 0 % )。结论PVTT患者能耐受手术者应积极肝癌切除并术中取栓治疗 ,术后经门静脉 ,肝动脉泵化疗或栓塞化疗能延长部分病人的生命 ,手术治疗优与介入治疗。
Objective To investigate the curative effect of combined treatment of patients with hepatocellular carcinoma and portal vein tumor thrombus (PVTT). Methods A total of 176 patients with hepatocellular carcinoma complicated with PVTT were enrolled in the study. The patients in the operation group received routine or irregular hepatectomy and were given portal vein thrombosis, portal vein or hepatic artery pump in 14 cases. Arterial embolization Chemotherapy. Results The 5-year, 1-year and 2-year survival rates of the operation group were 94%, 50% and 19% respectively. The common postoperative complications were 44% (14/32) of transient liver insufficiency, 31% of right pleural effusion (10 of 32), upper gastrointestinal bleeding of 2 8% (9/32), etc., without surgical death. Intervention group 0 5, 1-year survival rate was 35%, 0. In the intervention group, 34 patients with grade Ⅰ liver function had no significant difference in the age of patients and the size of the cancer focus compared with the operation group, but the 0 51 year survival rate (59%, 0) was significantly lower than that of the operation group (94%, 50%). Conclusion Patients with PVTT should be able to tolerate surgery should be actively removed and intraoperative thrombectomy, after surgery by portal vein, hepatic artery pump chemotherapy or embolization chemotherapy can prolong the lives of some patients, surgical treatment of superior and interventional treatment.