外科治疗原发性肝癌1102例

Surgical Treatment for 1102 Cases of Primary Liver Cancer

1960年1月至1989年12月经手术切除肝癌1102例,术后1个月内总死亡率为1.8％,术后全组1,3,5年生存率为64.8％,45.6％和28.2％。直径≤5cm组282例,无手术死亡,且术后1,3,5年生存率分别为89.5％,78.6％和75％。本组中78例术后复发进行了170次复发灶再切除,其中72例作了再次肝切除,接受手术次数最多者为4次(7例),6例再次切除肝外转移灶,术后1,3,5年生存率分别为100％、69.6％和54.7％,再次手术切除后为75％,34.6％和34％,存活最长1例已逾15年。此外,26例首次剖腹证实不能切除的大肝癌经缩小疗法后得到二期切除,术后1,3,5年生存率为96.2％,85.7％和60.0％。30年的肝癌外科治疗经验表明,肝癌的早期诊断和早期切除仍是提高肝癌外科疗效的关键,肝癌术后复发的再手术及对不能切除肝癌的二期切除,极大地扩大了肝切除在肝癌治疗中的应用范围,使部分不能切除或复发的肝癌获得切除的可能性。改进手术方法,减少并发症的发生,加强术后综合治疗,是提高手术成功率,巩固外科疗效的重要措施。

The purpose of this study was to retrospectively analyse the results of 1102 primary liver cancer (PLC) patients underwent liver resection in the past thirty years and to search some effective approaches for improving the longterm effect or PLC treatment. 95% were with hepatocellular carcinoma (HCC), 85.2% with cirrhosis of hepatitis and 25.6% with tumor equal to or smaller than 5 cm in diameter. The mortality rate (MR) within 1 month after operation was 1.8%, the operative MR was 8.8% before 1977 and only 0.4% after that. The total 5-year survival rate (SR) was 28.2% while in the group of small tumor (≤5cm), it was 75.0%. Our experience was as follows: (1) Early diagnosis and early resection of PLC is the key point for improving the operative result of longterm survival. In 282 cases of small cancer, tumor resection rate was 90.0%. Of 48 cases of tumor equal to or smaller than 3 cm in diameter, the 5-year SR was 83.3%. (2) .Rehepatectomy for recurrent liver cancer is an important approach for improving the surgical result. In our series, recurrent rate within 5 years postoperation was 72.3% in larger tumor group and 34.5% in small tumors. There were 78 cases undergoing reoperation in a total number of 170 times of rehepatectomy with 54.7% of 5-year SR after the 1st operation and 34.6% after the 2nd one. (3) For unresectable large tumors, two-stage operation is an important development in liver surgery. We had 26 cases of such patients with 60.0% of 5-year SR. (4) Improvement of operating techniques plays an important role in reducing postoperative complications, lowering operative mor- tality and obtaining better operative result. (5) Postoperative comprehensive treatments are also important for solidating operative effect and preventing tumor recurrence.