目的：探讨原发性肝癌（HCC）合并门静脉癌栓（PVTT）的外科治疗及疗效。方法：回顾性分析2010 年1 月—2013 年1 月收治的68 例HCC 合并PVTT 患者临床资料，其中50 例行手术（规则半肝+ 癌栓及受累门静脉切除术或不规则肝切除+ 门脉癌栓取出术）+ 经导管肝动脉化疗栓塞术（TACE）治疗（联合治疗组）；18 例患者单纯口服索拉非尼治疗（索拉非尼治疗组）。联合治疗组患者中，11 例PVTT 侵犯门静脉二级及以上分支，39 例侵犯门静脉一级分支；索拉非尼治疗组患者PVTT 侵犯部位均为门静脉一级分支。分析患者0.5、1、2、3 年生存率、总生存时间（OS）、疾病进展时间（TTP）。结果：联合治疗组PVTT 侵犯门静脉二级及以上分支患者与侵犯门静脉一级分支患者0.5、1、2、3 年生存率分别为100%、90.9%、18.2%、9.1% 与87.2%、51.3%、15.4%、5.1%；索拉非尼治疗组0.5、1、2、3 年生存率分别为83.3%、33.3%、0%、0%。联合治疗组PVTT 侵犯门静脉二级及以上分支患者与侵犯门静脉一级分支患者中位OS 为16 个月与12 个月，中位TTP 为7 个月与5 个月；索拉非尼治疗组中位OS 为9 个月，中位TTP 为4 个月。统计学分析显示，联合治疗组无论是PVTT 侵犯门静脉二级及以上分支或侵犯门静脉一级分支患者中位OS 及中位TTP 均明显长于索拉非尼治疗组（均P<0.05）。结论：对于合并门静脉一级及以上分支癌栓的晚期HCC 患者，可行外科手术联合术后TACE 治疗，且疗效优于单纯索拉非尼治疗。
Surgical resection plus transcatheter arterial chemoembolization for advanced hepatocellular carcinoma with portal vein tumor thrombus: an analysis of therapeutic efficacy
Objective: To investigate the surgical treatment for patients with hepatocellular carcinoma (HCC) and concomitant portal vein tumor thrombus (PVTT) and the efficacy. Methods: The clinical data of 68 HCC patients with PVTT treated from January 2010 to January 2013 were retrospectively analyzed. Of the patients, 50 cases underwent surgical treatment (regular hemihepatectomy plus involved portal vein resection, or irregular liver resection and PVTT removal) followed by transcatheter arterial chemoembolization (TACE) (combination treatment group), and 18 cases received treatment of oral sorafenib only (sorafenib treatment group). PVTT involved the second- or lower-order portal vein branches in 11 cases, and involved the first-order portal vein branches in 39 cases in combination treatment group, and all cases in sorafenib treatment group had PVTT in the first-order portal vein branches. The 0.5-, 1-, 2-, and 3-year survival rate, overall survival (OS) and time to tumor progression (TTP) of the patients were analyzed. Results: In combination treatment group, the 0.5-, 1-, 2-, and 3-year survival rate for patients with the secondor lower-order portal vein branch involvement was 100%, 90.9%, 18.2% and 9.1%, and for patients with the first-order portal vein branch involvement was 87.2%, 51.3%, 15.4% and 5.1%, which for patients in sorafenib treatment group was 83.3%, 33.3%, 0% and 0%, respectively. In combination treatment group, the median OS and TTP for patients with the second- or lower-order portal vein branch involvement was 16 and 7 months, and for patients with the first-order portal vein branch involvement was 12 and 5 months, which for patients in sorafenib treatment group was 9 and 4 months, respectively. Statistical analysis showed that both median OS and TTP for patients either with the second- or lower-order portal vein branch involvement, or the first-order portal vein branch involvement were significantly longer than those for patients in sorafenib treatment group (all P<0.05). Conclusion: Surgical resection followed with TACE treatment can be performed in patients with advanced HCC and PVTT involving the first- or lower-order portal branches, which may offer better efficacy than lone sorafenib administration.