• 廣西醫(yī)科大學(xué)第一附屬醫(yī)院肝膽外科（廣西南寧 530021）;

目的 　綜述肝癌合并門靜脈癌栓（PVTT）的治療現(xiàn)狀，以進一步提高其療效。
方法 　通過文獻檢索對近年來與肝癌合并PVTT有關(guān)的治療方法和治療效果進行總結(jié)。
結(jié)果 　PVTT是肝癌的常見合并癥，其治療方法有外科手術(shù)切除、肝動脈栓塞和化療、經(jīng)門靜脈治療、放射性治療、各種消融治療、分子靶向治療等；肝癌合并PVTT患者的手術(shù)切除率低，治療困難且預(yù)后差，療效有待提高。
結(jié)論 　肝癌合并PVTT的治療應(yīng)以手術(shù)為主，多學(xué)科、多手段聯(lián)合治療，并根據(jù)患者的病情及癌栓的情況進行個體化和序貫性的綜合治療，以提高肝癌合并PVTT患者的生存率。

引用本文： 肖開銀,彭民浩. 原發(fā)性肝癌合并門靜脈癌栓的治療進展. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(3): 259-265. doi: 復(fù)制

1. Takizawa D， Kakizaki S， Sohara N， et al. Hepatocellular carci noma with portal vein tumor thrombosis： clinical characteristics,prognosis， and patient survival analysis [J]. Dig Dis Sci， 2007,52(11)：3290-3295.
2. Cedrone A， Rapaccini GL， Pompili M， et al. Portal vein thrombosis complicating hepatocellular carcinoma. Value of ultrasoundguided fine-needle biopsy of the thrombus in the therapeutic management [J]. Liver， 1996， 16(2)： 94-98.
3. 陸婉玲， 黨亞正. 原發(fā)性肝癌并門靜脈癌栓的研究現(xiàn)狀 [J].西北國防醫(yī)學(xué)雜志， 2009， 30(2)：129-131.
4. Cabibbo G， Enea M， Attanasio M， et al. A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma [J]. Hepatology， 2010， 51(4)： 1274-1283.
5. Lau WY， Lai EC， Yu SC. Management of prtal vein tumor thrombus// Wy L ed Hepatocellular carcinoma [M]. Singapore：World Sientific Publishing Co， Pte. Ltd， 2008： 1-24.
6. Kondo K， Chijiiwa K， Kai M， et al. Surgical strategy for hepatocellular carcinoma patients with portal vein tumor thrombus based on prognostic factors [J]. J Gastrointest Surg， 2009， 13(6)：1078-1083.
7. Lin DX， Zhang QY， Li X， et al. An aggressive approach leads to improved survival in hepatocellular carcinoma patients with portal vein tumor thrombus [J]. J Cancer Res Clin Oncol， 2011,137(1)： 139-149.
8. Shuqun C， Mengchao W， Han C， et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein [J]. Hepatogastroenterology, 2007,54(74)： 499-502.
9. Shi J, Lai E, Li N, et al. Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus [J]. Ann Surg Oncol,2010， 17(8)： 2073-2080.
10. Yoshidome H， Takeuchi D， Kimura F， et al. Treatment strategy for hepatocellular carcinoma with major portal vein or inferior vena cava invasion： a single institution experience [J]. J Am Coll Surg， 2011， 212(5)： 796-803.
11. Shi J， Lai EC， Li N， et al. A new classification for hepatocellular carcinoma with portal vein tumor thrombus [J]. J Hepatobiliary Pancreat Sci， 2011, 18(1)： 74-80.
12. Ban D， Shimada K， Yamamoto Y， et al. Efficacy of a hepatectomy and a tumor thrombectomy for hepatocellular carcinoma with tumor thrombus extending to the main portal vein [J]. J Gastrointest Surg， 2009， 13(11)： 1921-1928.
13. Yamaoka Y， Kumada K， Ino K， et al. Liver resection for hepatocellular carcinoma (HCC) with direct removal of tumor thrombi in the main portal vein [J]. World J Surg， 1992， 16(6)： 1172-1176.
14. Inoue Y， Hasegawa K， Ishizawa T， et al. Is there any difference in survival according to the portal tumor thrombectomy method in patients with hepatocellular carcinoma? [J]. Surgery， 2009,145(1)： 9-19.
15. 鄭虹， 高偉， 朱志軍， 等. 肝移植治療肝細胞癌合并門靜脈癌栓的療效評價 [J]. 中華器官移植雜志， 2009， 30(8)：484-486.
16. Georgiades CS， Hong K， D’angelo M， et al. Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis [J]. J Vasc Interv Radiol， 2005， 16(12)： 1653-1659.
17. Carr BI， Irish W， Federle MP， et al. Chemoembolization for unresectable hepatocellular carcinoma in patients with or without portal vein thrombosis [J]. Hepatogastroenterology， 2010，57(104)： 1375-1381.
18. Luo J， Guo RP， Lai EC， et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis： a prospective comparative study [J]. Ann Surg Oncol，2011， 18(2)： 413-420.
19. 劉德鑫， 李新豐， 李華東， 等. 肝動脈栓塞化療對肝癌并門靜脈癌栓療效觀察 [J]. 中國基層醫(yī)藥， 2010， 17(2)：158-159.
20. Schwarz RE， Abou-Alfa GK，Geschwind JF， et al. Nonoperative therapies for combined modality treatment of hepatocellular cancer： expert consensus statement [J]. HPB (Oxford)， 2010，12(5)： 313–320.
21. Kim JH， Yoon HK， Kim SY， et al. Transcatheter arterial chemoembolization vs. chemoinfusion for unresectable hepatocellular carcinoma in patients with major portal vein thrombosis [J]. Aliment Pharmacol Ther， 2009， 29(12)： 1291-1298.
22. Chen LW， Chien RN， Fang KM， et al. Elucidating therapeutic effects on patients with hepatocellular carcinoma and main portal vein thrombosis [J]. Hepatogastroenterology， 2010， 57(98)：228-231.
23. Ikeda M， Okusaka T， Ueno H， et al. Hepatic arterial infusion chemotherapy with epirubicin in patients with advanced hepatocellular carcinoma and portal vein tumor thrombosis [J]. Oncology,2007， 72(3-4)： 188-193.
24. Tsai AL， Burke CT， Kennedy AS， et al. Use of yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis [J]. J Vasc Interv Radiol， 2010， 21(9)：1377-1384.
25. Luo J， Yan Z， Liu Q， et al. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein [J]. J Vasc Interv Radiol， 2011， 22(4)： 479-489.
26. Liang LJ， Hu WJ， Yin XY， et al. Adjuvant intraportal venous chemotherapy for patients with hepatocellular carcinoma and portal vein tumor thrombi following hepatectomy plus portal thrombectomy [J]. World J Surg， 2008， 32(4)： 627-631.
27. 張躍偉， 娜仁圖戈， 高飛， 等. 經(jīng)皮肝穿刺注射碘油化療藥物治療原發(fā)性肝癌門靜脈癌栓的臨床研究 [J]. 中國介入影像與治療學(xué)， 2009， 6(2)：167-169.
28. Marelli L， Shusang V， Buscombe JR， et al. Transarterial injection of (131) I-lipiodol, compared with chemoembolization， in the treatment of unresectable hepatocellular cancer [J]. J Nucl Med,中國普外基礎(chǔ)與臨床雜志2012 年3 月第19 卷第3 期 Chin J Bases Clin General Surg, Vol. 19, No. 3, Mar. 2012 ? 265 ?2009， 50(6)： 871-877.
29. Zhang FJ， Li CX， Jiao DC， et al. CT guided 125Iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma [J]. Chin Med J (Engl)， 2008， 121(23)： 2410-2414.
30. Zhang XB， Wang JH， Yan ZP， et al. Hepatocellular carcinoma with main portal vein tumor thrombus： treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolization [J]. Cancer， 2009， 115(6)： 1245-1252.
31. Kamiyama T， Nakanishi K， Yokoo H， et al. Efficacy of preoperative radiotherapy to portal vein tumor thrombus in the main trunk or first branch in patients with hepatocellular carcinoma [J]. Int J Clin Oncol， 2007， 12(5)： 363-368.
32. Sugahara S， Nakayama H， Fukuda K， et al. Proton-beam therapy for hepatocellular carcinoma associated with portal vein tumor thrombosis [J]. Strahlenther Onkol， 2009， 185(12)： 782-788.
33. Yamamoto K， Masuzawa M， Kato M， et al. Evaluation of combined therapy with chemoembolization and ethanol injection for advanced hepatocellular carcinoma [J]. Semin Oncol， 1997， 24 (2 Suppl 6)： S6-50-S6-55.
34. 王守華， 嵇雪琴， 李詠梅. 無水酒精注射術(shù)治療門靜脈癌栓25例 [J]. 現(xiàn)代腫瘤醫(yī)學(xué)， 2011， 19(2)：326-327.
35. Hirooka M， Koizumi Y， Kisaka Y， et al. Mass reduction by radiofrequency ablation before hepatic arterial infusion chemotherapy improved prognosis for patients with huge hepatocellular carcinoma and portal vein thrombus [J]. AJR Am J Roentgenol,2010， 194(2)： W221-W226.
36. Giorgio A， Di Sarno A， de Stefano G， et al. Hepatocellular carcinoma with cirrhosis： are patients with neoplastic main portal vein invasion eligible for percutaneous radiofrequency ablation of both the nodule and the portal venous tumor thrombus? [J]. AJR Am J Roentgenol， 2009， 193(4)： 948-954.
37. Lu ZH， Shen F， Yan ZL， et al. Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation [J]. J Cancer Res Clin Oncol， 2009， 135(6)： 783-789.
38. 黨亞正， 張學(xué)成， 陸婉玲， 等. 體部伽瑪?shù)杜c高強度聚焦超聲治療原發(fā)性肝癌門靜脈癌栓的臨床觀察 [J]. 現(xiàn)代腫瘤醫(yī)學(xué)，2010， 18(1)：114-117.
39. Irtan S， Chopin-Laly X， Ronot M， et al. Complete regression of locally advanced hepatocellular carcinoma induced by sorafenib allowing curative resection [J]. Liver Int， 2011， 31(5)： 740-743.
40. Ishizaki M， Kaibori M， Matsui K， et al. The effect of sorafenib and intermittent hepatic arterial infusion chemotherapy using cisplatin for advanced hepatocellular carcinoma with portal vein tumor thrombus—a pilot study [J]. Gan To Kagaku Ryoho， 2010,37(12)： 2679-2682.
41. Peng BG， He Q， Li JP， et al. Adjuvant transcatheter arterial chemoembolization improves efficacy of hepatectomy for patients with hepatocellular carcinoma and portal vein tumor thrombus [J]. Am J Surg， 2009， 198(3)： 313-318.
  1. 1. Takizawa D， Kakizaki S， Sohara N， et al. Hepatocellular carci noma with portal vein tumor thrombosis： clinical characteristics,prognosis， and patient survival analysis [J]. Dig Dis Sci， 2007,52(11)：3290-3295.
  2. 2. Cedrone A， Rapaccini GL， Pompili M， et al. Portal vein thrombosis complicating hepatocellular carcinoma. Value of ultrasoundguided fine-needle biopsy of the thrombus in the therapeutic management [J]. Liver， 1996， 16(2)： 94-98.
  3. 3. 陸婉玲， 黨亞正. 原發(fā)性肝癌并門靜脈癌栓的研究現(xiàn)狀 [J].西北國防醫(yī)學(xué)雜志， 2009， 30(2)：129-131.
  4. 4. Cabibbo G， Enea M， Attanasio M， et al. A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma [J]. Hepatology， 2010， 51(4)： 1274-1283.
  5. 5. Lau WY， Lai EC， Yu SC. Management of prtal vein tumor thrombus// Wy L ed Hepatocellular carcinoma [M]. Singapore：World Sientific Publishing Co， Pte. Ltd， 2008： 1-24.
  6. 6. Kondo K， Chijiiwa K， Kai M， et al. Surgical strategy for hepatocellular carcinoma patients with portal vein tumor thrombus based on prognostic factors [J]. J Gastrointest Surg， 2009， 13(6)：1078-1083.
  7. 7. Lin DX， Zhang QY， Li X， et al. An aggressive approach leads to improved survival in hepatocellular carcinoma patients with portal vein tumor thrombus [J]. J Cancer Res Clin Oncol， 2011,137(1)： 139-149.
  8. 8. Shuqun C， Mengchao W， Han C， et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein [J]. Hepatogastroenterology, 2007,54(74)： 499-502.
  9. 9. Shi J, Lai E, Li N, et al. Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus [J]. Ann Surg Oncol,2010， 17(8)： 2073-2080.
  10. 10. Yoshidome H， Takeuchi D， Kimura F， et al. Treatment strategy for hepatocellular carcinoma with major portal vein or inferior vena cava invasion： a single institution experience [J]. J Am Coll Surg， 2011， 212(5)： 796-803.
  11. 11. Shi J， Lai EC， Li N， et al. A new classification for hepatocellular carcinoma with portal vein tumor thrombus [J]. J Hepatobiliary Pancreat Sci， 2011, 18(1)： 74-80.
  12. 12. Ban D， Shimada K， Yamamoto Y， et al. Efficacy of a hepatectomy and a tumor thrombectomy for hepatocellular carcinoma with tumor thrombus extending to the main portal vein [J]. J Gastrointest Surg， 2009， 13(11)： 1921-1928.
  13. 13. Yamaoka Y， Kumada K， Ino K， et al. Liver resection for hepatocellular carcinoma (HCC) with direct removal of tumor thrombi in the main portal vein [J]. World J Surg， 1992， 16(6)： 1172-1176.
  14. 14. Inoue Y， Hasegawa K， Ishizawa T， et al. Is there any difference in survival according to the portal tumor thrombectomy method in patients with hepatocellular carcinoma? [J]. Surgery， 2009,145(1)： 9-19.
  15. 15. 鄭虹， 高偉， 朱志軍， 等. 肝移植治療肝細胞癌合并門靜脈癌栓的療效評價 [J]. 中華器官移植雜志， 2009， 30(8)：484-486.
  16. 16. Georgiades CS， Hong K， D’angelo M， et al. Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis [J]. J Vasc Interv Radiol， 2005， 16(12)： 1653-1659.
  17. 17. Carr BI， Irish W， Federle MP， et al. Chemoembolization for unresectable hepatocellular carcinoma in patients with or without portal vein thrombosis [J]. Hepatogastroenterology， 2010，57(104)： 1375-1381.
  18. 18. Luo J， Guo RP， Lai EC， et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis： a prospective comparative study [J]. Ann Surg Oncol，2011， 18(2)： 413-420.
  19. 19. 劉德鑫， 李新豐， 李華東， 等. 肝動脈栓塞化療對肝癌并門靜脈癌栓療效觀察 [J]. 中國基層醫(yī)藥， 2010， 17(2)：158-159.
  20. 20. Schwarz RE， Abou-Alfa GK，Geschwind JF， et al. Nonoperative therapies for combined modality treatment of hepatocellular cancer： expert consensus statement [J]. HPB (Oxford)， 2010，12(5)： 313–320.
  21. 21. Kim JH， Yoon HK， Kim SY， et al. Transcatheter arterial chemoembolization vs. chemoinfusion for unresectable hepatocellular carcinoma in patients with major portal vein thrombosis [J]. Aliment Pharmacol Ther， 2009， 29(12)： 1291-1298.
  22. 22. Chen LW， Chien RN， Fang KM， et al. Elucidating therapeutic effects on patients with hepatocellular carcinoma and main portal vein thrombosis [J]. Hepatogastroenterology， 2010， 57(98)：228-231.
  23. 23. Ikeda M， Okusaka T， Ueno H， et al. Hepatic arterial infusion chemotherapy with epirubicin in patients with advanced hepatocellular carcinoma and portal vein tumor thrombosis [J]. Oncology,2007， 72(3-4)： 188-193.
  24. 24. Tsai AL， Burke CT， Kennedy AS， et al. Use of yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis [J]. J Vasc Interv Radiol， 2010， 21(9)：1377-1384.
  25. 25. Luo J， Yan Z， Liu Q， et al. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein [J]. J Vasc Interv Radiol， 2011， 22(4)： 479-489.
  26. 26. Liang LJ， Hu WJ， Yin XY， et al. Adjuvant intraportal venous chemotherapy for patients with hepatocellular carcinoma and portal vein tumor thrombi following hepatectomy plus portal thrombectomy [J]. World J Surg， 2008， 32(4)： 627-631.
  27. 27. 張躍偉， 娜仁圖戈， 高飛， 等. 經(jīng)皮肝穿刺注射碘油化療藥物治療原發(fā)性肝癌門靜脈癌栓的臨床研究 [J]. 中國介入影像與治療學(xué)， 2009， 6(2)：167-169.
  28. 28. Marelli L， Shusang V， Buscombe JR， et al. Transarterial injection of (131) I-lipiodol, compared with chemoembolization， in the treatment of unresectable hepatocellular cancer [J]. J Nucl Med,中國普外基礎(chǔ)與臨床雜志2012 年3 月第19 卷第3 期 Chin J Bases Clin General Surg, Vol. 19, No. 3, Mar. 2012 ? 265 ?2009， 50(6)： 871-877.
  29. 29. Zhang FJ， Li CX， Jiao DC， et al. CT guided 125Iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma [J]. Chin Med J (Engl)， 2008， 121(23)： 2410-2414.
  30. 30. Zhang XB， Wang JH， Yan ZP， et al. Hepatocellular carcinoma with main portal vein tumor thrombus： treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolization [J]. Cancer， 2009， 115(6)： 1245-1252.
  31. 31. Kamiyama T， Nakanishi K， Yokoo H， et al. Efficacy of preoperative radiotherapy to portal vein tumor thrombus in the main trunk or first branch in patients with hepatocellular carcinoma [J]. Int J Clin Oncol， 2007， 12(5)： 363-368.
  32. 32. Sugahara S， Nakayama H， Fukuda K， et al. Proton-beam therapy for hepatocellular carcinoma associated with portal vein tumor thrombosis [J]. Strahlenther Onkol， 2009， 185(12)： 782-788.
  33. 33. Yamamoto K， Masuzawa M， Kato M， et al. Evaluation of combined therapy with chemoembolization and ethanol injection for advanced hepatocellular carcinoma [J]. Semin Oncol， 1997， 24 (2 Suppl 6)： S6-50-S6-55.
  34. 34. 王守華， 嵇雪琴， 李詠梅. 無水酒精注射術(shù)治療門靜脈癌栓25例 [J]. 現(xiàn)代腫瘤醫(yī)學(xué)， 2011， 19(2)：326-327.
  35. 35. Hirooka M， Koizumi Y， Kisaka Y， et al. Mass reduction by radiofrequency ablation before hepatic arterial infusion chemotherapy improved prognosis for patients with huge hepatocellular carcinoma and portal vein thrombus [J]. AJR Am J Roentgenol,2010， 194(2)： W221-W226.
  36. 36. Giorgio A， Di Sarno A， de Stefano G， et al. Hepatocellular carcinoma with cirrhosis： are patients with neoplastic main portal vein invasion eligible for percutaneous radiofrequency ablation of both the nodule and the portal venous tumor thrombus? [J]. AJR Am J Roentgenol， 2009， 193(4)： 948-954.
  37. 37. Lu ZH， Shen F， Yan ZL， et al. Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation [J]. J Cancer Res Clin Oncol， 2009， 135(6)： 783-789.
  38. 38. 黨亞正， 張學(xué)成， 陸婉玲， 等. 體部伽瑪?shù)杜c高強度聚焦超聲治療原發(fā)性肝癌門靜脈癌栓的臨床觀察 [J]. 現(xiàn)代腫瘤醫(yī)學(xué)，2010， 18(1)：114-117.
  39. 39. Irtan S， Chopin-Laly X， Ronot M， et al. Complete regression of locally advanced hepatocellular carcinoma induced by sorafenib allowing curative resection [J]. Liver Int， 2011， 31(5)： 740-743.
  40. 40. Ishizaki M， Kaibori M， Matsui K， et al. The effect of sorafenib and intermittent hepatic arterial infusion chemotherapy using cisplatin for advanced hepatocellular carcinoma with portal vein tumor thrombus—a pilot study [J]. Gan To Kagaku Ryoho， 2010,37(12)： 2679-2682.
  41. 41. Peng BG， He Q， Li JP， et al. Adjuvant transcatheter arterial chemoembolization improves efficacy of hepatectomy for patients with hepatocellular carcinoma and portal vein tumor thrombus [J]. Am J Surg， 2009， 198(3)： 313-318.