肝肿瘤专题研究(Monographic Study of Hepatic Tumors)

伴门静脉癌栓的原发性肝癌外科治疗:附335 例报告

Published at: 2015年第24卷第7期

王志明 1 , 胡宽 1 , 陶一明 1
1 中南大学湘雅医院 普通外科,湖南 长沙 410008
通讯作者 一明 陶 Email: yimingtao@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.07.003
基金:
国家自然科学基金资助项目 81372630,81372631
湖南省发改委科研基金资助项目 湘发改高技[2013]1199
中南大学湘雅医院2014 年度临床科研基金资助项目 2014L07

摘要

目的:探讨合并门静脉癌栓(PVTT)的肝癌手术治疗的指征与价值。方法:回顾性分析335 例伴PVTT 肝癌患者临床病理及随访资料,其中273 例行手术治疗,包括规则性或非规则性肝切除术(HR)+PVTT 清除术(HR 组),62 例采用肝动脉化疗栓塞(TACE)治疗(TACE组)。比较两组患者治疗后的生存情况。结果:HR 组及TACE 组中位生存期分别为4.46 个月和5.65 个月,差异无统计学意义(P=0.455);6、12 个月生存率分别为30.7%,38.7% 与12.1%、19.2%,差异均无统计学意义(均P>0.05)。结论:肝癌合并PVTT 不是手术禁忌证,实施HR 安全可行,但预后改善不明显,故要遵循个体化标准,慎重选择手术治疗。随着肝癌多学科协作(MDT)治疗及未来精准医学治疗模式的发展,以期能提高其整体治疗水平。


Surgical treatment strategy for primary liver cancer with portal vein tumor thrombus: a report of 335 cases

Abstract

Objective: To investigate the indication and value of surgical treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods: The clinicopathologic and follow-up data of 335 patients with HCC and PVTT were retrospectively analyzed. Of the patients, 273 cases underwent surgical treatment that included anatomic or non-anatomic liver resection (HR) plus PVTT removal (HR group), and 62 cases were subjected to transcatheter arterial chemoembolization (TACE) treatment (TACE group). The post-treatment survival between the two groups of patients was compared. Results: The median survival time for HR group and TACE group was 4.46 and 5.65 months, respectively, which had no significant difference (P=0.455); the 6- and 12-month survival rate for HR group was 30.7% and 12.1%, for TACE group was 38.7% and 19.2% respectively, which also showed no significant difference (both P>0.05). Conclusion: Concomitant PVTT in HCC is not a surgical contraindication, for which HR is safe and feasible, but offers no obvious survival advantage, so the option of surgical treatment should be considered cautiously according to the individualized assessments. The overall therapeutic effectiveness on this condition can be improved by the development of multi-disciplinary team (MDT) and precise medicine model in HCC treatment.


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引用

引用本文: 志明 王, 宽 胡, 一明 陶. 伴门静脉癌栓的原发性肝癌外科治疗:附335 例报告[J]. 中国普通外科杂志, 2015, 24(7): 928-932.
Cite this article as: WANG Zhiming, HU Kuang, TAO Yiming . Surgical treatment strategy for primary liver cancer with portal vein tumor thrombus: a report of 335 cases[J]. Chin J Gen Surg, 2015, 24(7): 928-932.