肝细胞癌伴门静脉癌栓转化治疗进展

Progress in Transformation Therapy of Hepatocellular Carcinoma with Portal Vein Cancer Thrombus

摘要: 肝细胞癌伴门静脉癌栓发生率高，预后差，现有治疗方式仍存在较大争议。在最新版肝细胞癌合并门静脉癌栓诊疗指南中已明确推荐癌栓侵犯门静脉一级或二级的患者(程氏分型I/II型)，首选手术切除。然而临床中有相当一部分患者的病灶范围较广或癌栓侵及门静脉主干(程氏III型)无法根治性切除，需要经转化降期治疗后再手术切除。笔者结合国内外相关文献报道，发现通过肝动脉化疗栓塞术、肝动脉灌注化疗、放疗、免疫及靶向等治疗方法，部分患者可出现门静脉癌栓消退、肿瘤体积缩小，从而使病灶降期，转化成功并接受根治性手术从而延长了生存时间。同时，多学科之间的相互协作对进一步提高转化切除率也举足轻重。

Abstract: Hepatocellular carcinoma with portal vein thrombectomy has a high incidence and poor prognosis, and the existing treatment methods are still controversial. In the latest edition of the guidelines for the diagnosis and treatment of hepatocellular carcinoma complicated with portal vein thrombectomy, it is clearly recommended that surgical resection be the first choice for patients with portal vein thrombectomy at Grade I or Grade II (Cheng’s type I/II). However, in clinical prac-tice, a considerable number of patients with a wide range of lesions or cancer embolism and main portal vein (Cheng’s Type III) cannot be radically resected, and need to undergo transformation downphase treatment before surgical resection. Combined with relevant literature reports at home and abroad, the author found that through the treatment methods of hepatic artery che-moembolization, hepatic artery infusion chemotherapy, radiotherapy, immunization and targeting, some patients could have the regression of portal vein cancer thrombus and tumor volume reduction, thus making the lesion downphase, and successfully transforming and receiving radical surgery, thus extending the survival time. At the same time, multidisciplinary cooperation is also important to further improve the conversion reduction rate.