肝癌术后复发原因的探讨

Inquiring the causes of recurrence of hepatocellular carcinoma after surgical resection

目的 通过对原发性肝癌手术后复发的血管造影、介入治疗和复发原因的探讨，以期改进肝癌术后复发的诊断、治疗和预防。方法 分析１４２ 例肝癌复发病例，详细观察术前肿瘤的大小、数量、大体病理或显微病理所见、复发肿瘤的时间、大小、数量、血供、染色和碘油沉积等情况。所有患者在造影后即行动脉内灌注化疗药物、碘油和（或）明胶海绵栓塞。结果 原发肿瘤＞５ ｃｍ 者１０１ 例，占７１ ．１％ ；＜ ５ ｃｍ 者４１ 例，占２８．９ ％ 。包膜不完整和无包膜者９６ 例，占６７．６％ 。术中发现肿瘤旁子灶４７ 例，占３３．１ ％ ；门静脉癌栓２６ 例，占１８．３ ％ 。病理中发现子灶９４ 例，占６６ ．２％ ；门静脉癌栓１２１例，占８５．２％ 。术后６ 个月以内复发者９９ 例，占６９．７％ 。复发灶多为＜ ５ ｃｍ 的多发性结节９７ 例，占６８．３ ％ 。肿瘤血供丰富者１００ 例，占７０．４ ％ 。介入治疗后，碘油沉积良好者９３ 例，占６５ ．５ ％ 。结论原发性肝细胞癌＞ ５ ｃｍ 、无包膜或包膜不完整、有卫星灶和门静脉癌栓者手术后复发率高，应在术后１～２ 个月内做肝动脉造影和化疗，以尽早明确有无复发并及时给予治疗，以期起到预防复发的作用。复发灶血供多丰富，介入治疗碘油沉?

Objective To analyze the causes of recurrence of hepatocellular carcinoma (HCC) after resection according to pathologic findings of the resected primary tumor and angiographic features of the recurrent tumor.Methods In this series, 142 cases with recurrent HCC were analyzed with respect to (1) size, number, gross and histologic findings of the primary tumor, (2) time when recurrence occurred, (3) size, number, blood supply, staining property of, and deposition of lipiodol oil in the recurrent tumor. Following angiography, arterial embolization was performed.Results In 101 of the 142(71.1%) cases, the primary tumor was >5 cm in diameter, and in 41 cases (28.9%) it was <5 cm. In 67.7% of the cases, the capsule of the primary tumor was incomplete or absent. In 47 cases (33.1%), satellite tumor nodules were seen during operation but they were seen on pathologic sections in 94 cases (66.2%). Tumor thrombus was present in the portal vein in 26 (18.3%) and 121 cases (85.2%) during operation and on pathologic examination, respectively. In the majority of the cases (99/142), recurrence occurred within 6 months after operation. The recurrent foci consisted of multiple tumor nodules of <5 cm in 68.3% of the cases. On angiography, the recurrent tumors were rich in blood supply with good deposition of lipiodol.Conclusion Recurrence is apt to occur in HCC patients with large (>5 cm) primary tumor which has incomplete or no capsule, satellite tumor nodules and portal vein tumor thrombus. It is suggested to perform angiography 1～2 months after surgery to detect early recurrence and, if confirmed, the patients can be treated by transcatheter arterial chemo embolization.