中国实用外科杂志

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肝癌合并门静脉癌栓诊治难点及对策

孙居仙,石    洁,程树群   

  1. 第二军医大学附属东方肝胆外科医院肝外六科,上海200438
  • 出版日期:2016-06-01 发布日期:2016-05-31

  • Online:2016-06-01 Published:2016-05-31

摘要:

肝癌发生发展过程中易于侵犯门静脉形成门静脉癌栓,由于病情进展迅速且缺乏有效的治疗手段,是造成肝癌整体预后差的主要原因之一。程氏分型的提出对评估门静脉癌栓病人病情、选择治疗方案及监测预后提供了科学的依据,但目前门静脉癌栓的诊治存在诸多难点:如何与门静脉血栓相鉴别、如何降低术后复发率、如何正确选择初始治疗、如何进行多学科联合治疗等,对提高门静脉癌栓病人疗效尤为重要,且目前国内尚缺乏统一的共识或规范来指导门静脉癌栓的诊治。将来亟待开发新的有效治疗手段,采用多学科综合治疗共同探讨个性化治疗方式,设计并开展更多临床随机对照研究,规范门静脉癌栓诊疗路径以提高疗效。

关键词: 门静脉癌栓, 肝癌

Abstract:

Difficulties and countermeasures of diagnosis and treatment for hepatocellular carcinoma with portal venous tumor thrombus        SUN Ju-xian,SHI Jie,CHENG Shu-qun. No. 6 Department of Hepatic Surgery, Eastern Hepatobiliary Surgical Hospital, the Second Military Medical University, Shanghai 200438,China
Corresponding author:CHENG Shu-qun,E-mail:chengshuqun
@aliyun.com
Abstract    Hepatocellular carcinoma (HCC) is prone to invade portal vein system known as portal vein tumor thrombus (PVTT). PVTT is one of the main reasons for poor prognosis of HCC because of its rapid progress and lack of effective treatments. Cheng’s classification provides a scientific basis for disease evaluation,treatment options and prognosis monitoring. But there are still many difficulties of diagnosis and treatment of PVTT at present:how to identify with portal venous thrombosis;how to reduce the postoperative recurrence rate;how to choose the initial treatment correctly;how to carry out the multidisciplinary treatment;and there is no national consensus to guide the diagnosis and treatment of PVTT. New effective therapeutic methods should be developed,and multidisciplinary treatment should be used to set personalized treatment in the future. More clinical randomized controlled study also should be carried out to standardize the diagnosis and treatment of PVTT.

Key words: portal venous tumor thrombus, hepatocellular carcinoma