CAJ | 학술논문

目的探讨肝细胞癌(HCC)伴门脉癌栓(PVTT)两种手术方式的疗效及预后因素.方法回顾性分析1995年1月至2010年12月广西医科大学附属肿瘤医院手术切除治疗的143例HCC伴Ⅰ或Ⅱ型癌栓患者的临床资料.根据门脉癌栓的不同处理方式将患者分为两组,A组1 15例,采用肝癌联合门脉癌栓切除;B组28例,采用肝癌切除联合门脉切开取栓或肝创面取栓.结果 A组患者中位生存时间为18.0个月,1、2、3年生存率分别为60.6％、41.0％、25.6％;B组患者的中位生存时间为7.0个月,1、2、3年生存率分别为35.1％、13.6％、9.1％,差异有统计学意义(P＜0.001).单因素分析显示肿瘤个数、癌栓类型、术后预防性肝动脉化疗栓塞(TACE)、癌栓处理方式为患者预后的影响因素(P＜0.05).多因素分析表明术后预防性TACE、癌栓处理方式为影响患者预后的独立因素.结论肝癌联合门脉癌栓切除患者的长期生存时间优于肝癌切除联合门脉切开取栓或肝创面取栓,术后辅以预防性TACE治疗,可以进一步改善HCC伴PVTT患者的预后.
목적 탐토간세포암(HCC)반문맥암전(PVTT)량충수술방식적료효급예후인소.방법 회고성분석1995년1월지2010년12월엄서의과대학부속종류의원수술절제치료적143례HCC반Ⅰ혹Ⅱ형암전환자적림상자료.근거문맥암전적불동처리방식장환자분위량조,A조1 15례,채용간암연합문맥암전절제;B조28례,채용간암절제연합문맥절개취전혹간창면취전.결과 A조환자중위생존시간위18.0개월,1、2、3년생존솔분별위60.6％、41.0％、25.6％;B조환자적중위생존시간위7.0개월,1、2、3년생존솔분별위35.1％、13.6％、9.1％,차이유통계학의의(P＜0.001).단인소분석현시종류개수、암전류형、술후예방성간동맥화료전새(TACE)、암전처리방식위환자예후적영향인소(P＜0.05).다인소분석표명술후예방성TACE、암전처리방식위영향환자예후적독립인소.결론 간암연합문맥암전절제환자적장기생존시간우우간암절제연합문맥절개취전혹간창면취전,술후보이예방성TACE치료,가이진일보개선HCC반PVTT환자적예후.
Objective To study the impact of two surgical techniques in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).Methods A retrospective study was conducted on 143 patients with HCC with PVTT who underwent hepatectomy from January 1995 to December 2010 at the Affiliated Tumor Hospital of Guangxi Medical University.The patients were divided into two groups:group A,115 patients who underwent resection of HCC with PVTT; group B,28 patients who underwent HCC resection but the PVTT was extracted from the cut opening of the portal vein or the transected liver parenchyma.Results The median overall survival of group A was 18.0 months and the cumulative 1-,2-,3-year survival rates were 60.6％,41.0％,25.6 ％,respectively; the median overall survival of group B was 7.0 months and the cumulative 1-,2-,3-year survival rates were 35.1％,13.6％,9.1％,respectively.The differences between the 2 groups were statistically significant (P ＜ 0.001).Univariate analysis showed tumor number,PVTT types,prophylactic transcatheter arterial chemoembolization (TACE),and surgical technique to be significant risk factor of postoperative overall survival (P ＜ 0.05).Cox multivariate analysis indicated prophylactic TACE and surgical technique to be independent prognostic factor (P ＜ 0.05).Conclusions When compared with group B patients,group A patients had significantly better overall survival.Postoperative prophylactic TACE further improved survival of these patients.