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目的 比较肝细胞癌合并门静脉癌栓 (tumorthrombiinportalvein ,PVTT)不同治疗方法的疗效及其意义。方法 147例肝细胞癌伴门静脉主干或第 1分支癌栓的住院患者 ,按不同治疗方法分成 4组 :保守治疗组 (A组 ,18例 ) ;肝动脉结扎和 (或 )肝动脉插管化疗组 (B组 ,18例 ) ,术后定期栓塞化疗 ;肝癌联同PVTT切除组 (C组 ,79例 ) ;手术切除 +肝动脉化疗栓塞和 (或 )肝动脉置管或门静脉置管组 (D组 ,32例 )。结果 A组中位生存期 2个月 ,1,3,5年生存率分别为 5 .6 % ,0 ,0。B组中位生存期 5个月 ,术后 1,3,5年生存率分别为 2 2 .2 %、5 .6 %和 0。C组中位生存期 12个月 ,术后 1,3,5年生存率分别为 5 3.9%、2 6 .9%和 16 .6 %。D组中位生存期 16个月 ,术后 1,3,5年生存率分别为 82 .8%、48.8%和 41.3%。各组生存率比较 ,差异均有显著性 (P <0 .0 5 )。结论 肝细胞癌伴PVTT行手术切除可明显提高疗效 ,改善患者生活质量 ,延长生存期 ,而手术切除后辅以肝脏区域性化疗或栓塞化疗可进一步延长生存期
Objective To compare the efficacy and significance of different treatment methods for hepatocellular carcinoma combined with tumor thrombi in portal vein (PVTT). Methods Four hundred and forty-four hospitalized patients with hepatocellular carcinoma and portal vein trunk or first branch cancer embolus were divided into 4 groups according to different treatment methods: conservative treatment group (group A, 18 cases); hepatic artery ligation and/or hepatic artery catheterization chemotherapy Group (group B, 18 cases), postoperative embolization chemotherapy; liver cancer combined with PVTT resection group (C group, 79 cases); surgical resection + hepatic arterial chemoembolization and/or hepatic artery catheterization or portal vein catheterization group ( Group D, 32 cases). Results The median survival time of group A was 2 months, and the 1-, 3-, and 5-year survival rates were 5.6 % and 0, 0, respectively. The median survival time was 5 months in group B, and the postoperative 1, 3, and 5-year survival rates were 22.2%, 5.6%, and 0, respectively. The median survival time in group C was 12 months. The postoperative 1, 3, and 5-year survival rates were 5 3.9%, 26.9%, and 16.6%, respectively. The median survival time was 16 months in group D, and the postoperative 1, 3, and 5-year survival rates were 82.8%, 48.8%, and 41.3%, respectively. The survival rate of each group was significantly different (P < 0.05). Conclusions Hepatoma with PVTT can significantly improve the curative effect, improve the quality of life of patients, and prolong the survival period. After surgery, combined with regional liver chemotherapy or embolization can further extend the survival period.