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目的 探讨原发性肝癌(HCC)合并门静脉癌栓(TTPV)的外科治疗方式选择。方法对1990年1月至2003年1月期间收治的138例肝癌合并门静脉癌栓患者的临床资料进行分析和总结。结果 37例行保守姑息治疗患者1至8个月内死亡,平均生存时间3 9个月。101例患者行手术治疗,其中23例行单纯肝癌切除术,平均生存时间10 9个月; 78例采取各种手术方式行肝癌切除加门静脉癌栓取栓术,平均生存时间26 8个月。其中52例术后采用了肝动脉和门静脉双插管微量泵灌注化疗,其1、3、5年生存率为96 2%、51 .9%、11 .5%, 26例未行插管化疗, 1、3、5年生存率为76 .9%、23 .1%、0%。结论 手术治疗比保守治疗能相对延长肝癌合并门静脉癌栓患者的生存时间;手术在切除肝癌的同时应尽量使用各种方式取出门静脉癌栓;术后使用肝动脉和门静脉双插管微量泵灌注化疗可有效提高治疗效果。
Objective To investigate the surgical treatment of primary hepatic carcinoma (HCC) combined with portal vein tumor thrombus (TTPV). Methods The clinical data of 138 patients with hepatocellular carcinoma with portal vein tumor thrombus admitted from January 1990 to January 2003 were analyzed and summarized. Results 37 patients with conservative palliative treatment within 1 to 8 months of death, the average survival time of 39 months. 101 patients underwent surgical treatment, of which 23 patients underwent simple hepatectomy with an average survival time of 109 months. In all, 78 patients underwent hepatectomy and portal vein tumor embolization with a mean of 268 months. Among them, 52 cases were treated with double cannula infusion of hepatic artery and portal vein after chemotherapy. The 1, 3, 5 year survival rates were 96.2%, 51.9% and 11.5%, respectively. Twenty-six patients underwent intubation chemotherapy The 1, 3, 5-year survival rates were 76.9%, 23.1%, 0%. Conclusion Surgical treatment can prolong the survival time of patients with hepatocellular carcinoma and portal vein tumor thrombus by conservative treatment. Surgical resection of liver cancer should use portal vein embolism in various ways as far as possible. Postoperative use of double cannula infusion of hepatic artery and portal vein infusion chemotherapy Can effectively improve the treatment effect.