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目的：评价不同影像手段对发现门静脉癌栓（ＰＴＴ）的敏感性与左右叶肝癌病灶对门静脉侵犯程度的差异，以及门静脉受侵时介入治疗方案的选择。材料与方法：对２８例合并ＰＴＴ的原发性肝癌进行了肝动脉化疗栓塞，此前分别作了Ｂ超、ＣＴ与血管造影，比较这些检查对发现ＰＴＴ的敏感性。同时将同期血管造影显示门静脉通畅的５６例原发性肝癌作为对照组。结果：２８例血管造影病例中２４例（８５．７％）门静脉显示清楚者均发现ＰＴＴ，Ｂ超与ＣＴ检查的ＰＴＴ发现率分别为７６％与３８．５％。２８例中左内叶有病灶者占５３．６％，而无ＰＴＴ的对照组中仅占１７．９％。同时，主灶位于左内叶者明显小于位于右叶者（Ｐ＜０．０１）。２８例中血管造影１８例显示肝动脉门静脉瘘，瘘口均位于病灶所在部位。所有病灶治疗后均未出现严重肝功能损害。结论：Ｂ超与血管造影对发现门静脉癌栓较敏感；左内叶病灶更易侵犯门静脉；门静脉受侵后亦应积极治疗。
OBJECTIVES: To evaluate the sensitivity of different imaging methods for the detection of portal vein tumor thrombosis (PTT) and the difference in the extent of invasion of the portal vein between left and right lobe liver cancer lesions, and the choice of interventional treatment options for portal vein invasion. Materials and Methods: Hepatic arterial chemoembolization was performed on 28 cases of primary hepatocellular carcinoma with PTT. B-ultrasonography, CT, and angiography were performed before. The susceptibility to PTT was compared. At the same time, 56 cases of primary hepatocellular carcinoma with patency in the portal vein during the same period served as the control group. RESULTS: Of the 28 angiographic cases, 24 (85.7%) had PTT detected with clear portal veins, and PTT findings with B-mode ultrasonography and CT were 76% and 38.5%, respectively. Of the 28 cases, lesions in the left internal lobe accounted for 53.6%, whereas those in the control group without PTT accounted for only 17.9%. At the same time, the main focus of the left lobe was significantly smaller than that of the right lobe (P<0.01). In 28 cases, 18 cases of angiography showed hepatic arterial portal vein fistula, and the fistula was located at the site of the lesion. None of the lesions had severe liver damage after treatment. Conclusion: B-ultrasonography and angiography are more sensitive to the discovery of portal vein tumor emboli; left lobe lesions are more likely to invade the portal vein; portal vein should also be actively treated after invasion.