60例隐匿性肝癌的临床诊疗策略

Clinical Strategy of Subclinical Hepatocellular Carcinoma(A Report of 60 Cases)

目的研究隐匿性肝癌治疗的临床诊疗策略。方法回顾性分析60例隐匿性肝癌患者的临床资料,其中45例合并肝硬化,47例HBsAg阳性;AFP<20μg/L 12例,20~400μg/L 31例,>400μg/L 17例;肝功能Ch ild-Pugh A级36例,B级24例。42例予不规则肝切除(7例同时行脾切除加贲门周围血管离断术),3例予不规则肝切除加无水酒精注射,15例予肝左外叶切除(2例同时取出门静脉左支癌栓)。结果术中中位出血量800(400~2 500)m l,输血745(400~2 000)m l,无围术期死亡,术后出现腹水12例(20.0%),胸腹积液6例(10.0%),上消化道出血、肺部感染、胆漏及肝创面渗血各1例(2.2%),均经非手术治疗治愈。术后1、3、5年生存率分别为85.0%,66.7%,40.0%。结论除AFP外,多种肝癌标志物的研究有可能提高隐匿性肝癌的诊断效果,手术切除是最有效的治疗方法,但应结合肿瘤位置、大小、患者肝功能分级等因素确定手术及综合治疗方案。

Objective To summarize the experiences of the surgery strategies for the subclinical hepatocellular carcinoma(SHC).Methods The clinic data of 60 SHC cases were retrospectively analyzed.Among them,47 cases were HBsAg positive,and the fetoprotein level was <20μg/L in 12 cases,20~400μg/L in 31 cases and >400μg/L in 17 cases.The liver function of Child-Pugh A was found in 36 cases,B in 24 cases.42 cases underwent irregular hepatectomy(including 7 cases of splenectomy and vessel amputation of the pericardi...