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目的探讨选择性门静脉栓塞化疗对原发性肝癌的治疗效果。方法对38例合并门静脉瘤栓的原发性肝癌患者在行肝动脉栓塞化疗（TAE）基础上，联合应用经皮经肝选择性门静脉栓塞化疗术（SPVE）。33例为块状型，5例为结节型，其中直径大于10cm24例，5～10cm11例，小于5cm3例，肿瘤位于肝右叶29例，肝左叶6例，左右叶3例。血清AFP检测＞400ug／L21例，在200ug／L～400ug／L之间6例，（一）／＜200ug／L11例。门静脉瘤栓位于右支19例，左支者7例，右支＋主干6例，左支＋主干2例，左右支＋主干4例。结果治疗后门静脉瘤栓消失和缩小率为68．4％，肿瘤缩小率为76．3％，AFP转阴14例，4例呈一过性转阴或下降，总有效率为85．7％。9例获二期手术切除，术后病理证实，门静脉癌栓坏死率100％。术后随访，1年，3年存活率分别为73．7％和18．4％，远比单纯TAE治疗组高。结论选择性门静脉栓塞化疗是治疗肝癌合门静脉癌栓的有效方法。
Objective To investigate the therapeutic effect of selective portal vein embolization chemotherapy on primary liver cancer. Methods 38 cases of primary liver cancer patients with portal vein tumor embolus were treated with hepatic artery embolization chemotherapy (TAE) combined with percutaneous transhepatic selective portal vein embolization chemotherapy (SPVE). 33 cases were massive and 5 cases were nodular, of which 24 cases were larger than 10 cm in diameter, 11 cases were 5 to 10 cm, and 3 cases were less than 5 cm. The tumor was located in 29 cases of right hepatic lobe, 6 cases of left hepatic lobe, and 3 cases of left and right lobe. Serum AFP detection> 400ug/L 21 cases, 200ug/L ~ 400ug/L 6 cases, (a) / <200ug/L11 cases. The portal vein tumor thrombus was located in 19 cases in the right branch, 7 cases in the left branch, 6 cases in the right branch and trunk, 2 cases in the left branch and trunk, and 4 cases in the left branch and the trunk. Results The rate of disappearance and reduction of portal vein tumor emboli after treatment was 68.4%, the tumor reduction rate was 76.3%, AFP was negative in 14 cases, and 4 cases were transiently negative or declining. The total effective rate was 85.7%. . Nine cases received second-stage surgical resection. Postoperative pathology confirmed that the portal vein tumor embolus necrosis rate was 100%. After follow-up, the 1-year and 3-year survival rates were 73.7% and 18.4%, respectively, which were much higher than those of the pure TAE treatment group. Conclusion Selective portal vein embolization chemotherapy is an effective method to treat hepatocellular carcinoma and portal vein tumor thrombus.