目的探讨经药物传输泵（DDS）门静脉化疗（PVC）联合肝动脉插管化疗栓塞（TACE）]治疗肝细胞癌伴门静脉癌栓的临床疗效及安全性。方法对87例肝细胞癌合并门静脉癌栓患者手术切除肿瘤并取出癌栓，再随机将患者分成3组。A组行TACE、B组行经DDS泵PVC，C组行经DDS泵PVC联合TACE。随访3年。结果 C组患者术后6个月、1年、2年和3年无瘤生存率分别为93.5%、80.6%、41.9%和29.0%，累积生存率分别为96.8%、87.1%、54.8%和45.2%，其中2年和3年生存率显著高于A组和B组（P均<0.05）；C组患者术后6个月、1年、2年和3年上消化道出血发生率分别为0%、0%、16.1%和22.6%，与A组和B组比无显著性差异（P均>0.05）。结论对肝细胞癌合并门静脉癌栓患者行手术切除肿瘤并取出癌栓后，行双途径化疗可有效提高患者无瘤生存率及累计生存率。%Objective To observe the survival of patients with hepatocellular carcinoma(HCC)complicated by portal vein tumor thrombus (PVTT)receiving transcatheter arterial chemoembolization (TACE)and portal vein chemotherapy(PVC)after resection of tumors. Methods Eighty-seven patients with HCC complicated by PVTT had tumor resection and removal of PVTT. After the operation,the patients were randomly divided into three groups. The patients in group A,B and C were treated by TACE,by PVC and by TACE combined with PVC,respectively. The patients in the three groups were followed-up for three years. Results The tumor free survivals in group C six months,one year,two years and three years after the treatment were 93.5%,80.6%,41.9% and 29.0%,and the accumulative survival rates were 96.8%,87.1%,54.8% and 45.2%,respectively. Out of them,the survivals at two and three years were much higher than those in group B and C (P<0.05);the incidence of upper gastrointestinal bleeding in group C in six months,one year,two years and three years were 0%,0%,16.1% and 22.6%,respec-tively,without significant difference as compared to those in group A and B (P均>0.05). Conclusion The TACE and PVC are alternative approach in patients with HCC complicated by PVTT,which might improve the tumor-free survival and the accumulative survival rates.
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