| Primary liver cancer(PLC) has a great tendency to invade portal vein intravascularly, which lends to the formation of portal vein tumor thrombus( PVTT)0 PLC with PVTT in the main trunk or in the first branch is considered to be late stage of liver cancer, resulting in the poor prognosis of patients. Until now, patients with PVTT still have no effective treatments. Patients with conservative therapy have medium survival time less than 3m and nearby 0% 3-year survival rate. Whereas patients after resection and sequential comprehensive treatments have 3 and 5-year survival rates of 20% and 0%. In a word , PVTT is an important factor relating with tumor intrahepatic metastasis and recurrence after operation. To study the mechanism of the PVTT formation and to explore more effective treatment measures of PVTT, 917 patients of PLC after consequtive operation from Feb. 1996 to Oct. 2003 administrated in our hospital were analyzed retrospectively.U Analysis of clinical features of PVTT (1) Incidence and diagnosis of PVTTOBJECTIVE: To study the diagnosis and incidence of PVTT. METHODS: 917 consequtive patients of PLC were registed in our clinical data, the clinical features and diagnosis of PVTT was analyzed. RESULTS: Among 917 patients, the number of gross PVTT (PVTT in the main trunk or the first ^second branch) , microscopic PVTT and no PVTT were 139(15.2%), 540(58.9%) and 238(25.9%). Among 139 patients with gross PVTT, 92 (66.2%) patients were detected by preoperative examination, 32(23. 0%) patients were detected during operation and 15 (10.8%) patients were until postoperative pathologic examination. CONCLUSION: PLC had high incidence of PVTT. Although some were detected by preoperative screenage examination, quite a lot of patient were detected by operative exploration. Therefore, careful exploration and intraoperative ultrasonography (IOUS) was helpful for the detection of PVTTduring operation.(2) The relationship of tumor location and gross PVTTOBJECTIVE: To study the relationship between the tumor location and gross PVTT invasion. METHODS: The relationship between the pattern growth of PVTT and tumor location in 917 patients were analyzed. RESULTS: Patients shared different incidence of PVTT with different tumor location, the PVTT incidence was 15.9%, 13.8% and 17.5% respectively when tumor was local in left lobe , right lobe of liver and the whole liver. Tumor location had no significant relationship with PVTT incidence (P=0. 219) . The relationship between tumor location and growth pattern of PVTT was detailed described as follow: tumor with the same side PVTT 83. 5%, tumor with the opposite side PVTT 3. 6% and tumor with both side PVTT 12. 9%. Tumor location had closed relationship with growth pattern (P<0.01) . For gross PVTT, tumor in right lobe of liver (26.7%) or more than half of liver (26. 7%) accompanied a higher frequency to grow in main truck of portal vein than that in left lobe of liver(8. 6) (P<0. 05). CONCLUSION: Tumor location didn' t affect the incidence of PVTT but it has significant correlation with the growth pattern of PVTT. PVTT used to grow in portal vein on the same side of the lobe of the main tumor. The tumors in right lobe and over half of liver were easier to grow in main truck of portal vein than the tumors in left lobe.(3) The relationship of HCC Pathology and gross PVTTOBJECTIVE: To study the relationship between PVTT and the pathological features of PLC. METHODS: The relationship between PVTT incidence and the pathological features were analyzed. RESULTS: Patients with PVTT could easily be seen in those whose diameter of tumor >5cm(p=0. 003), encapsulation was absence (P=0.000), HCC histological differentiation was no more than III(P=0.009), serum AFP level was no less than 400ug/L(P=0. 022). CONCLUSION: PVTT incidence has significant correlation with tumor size, encapsulation and histological differentiation. And pathological types of PLC, tumor number andliver cirrhosis have no significant relationship with PVTT incidence. In our study, we found that serum AFP lev...
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