巨大肝癌的手术治疗(附106例报告)

Surgical treatment of huge primary liver cancer: a report of 106 cases

目的 探讨巨大肝癌手术切除的可能性及手术方法。方法 10 6例巨大肝癌 ,肿瘤直径 10～ 2 5cm ,平均直径 13cm。伴有肝硬化者占 92 5 %。全部病例均经手术治疗 ,采用右肋缘下或双侧肋缘切口 ,常温下间歇性阻断肝门 ,阻断时间 15～ 2 0min ,最多阻断 2次。根据肿瘤部位及手术方式的不同 ,对第一、二、三肝门进行解剖。结果 全组无手术死亡 ,右侧胸腔积液 32例 ,膈下感染 2例 ,上消化道出血 2例。经对症处理后均痊愈。随访 1～ 2年 ,1年生存率 75 % (79/ 10 6 )。结论 对于单发的巨大肝癌 ,应采用手术切除为主的综合治疗 ,巨大肝癌的切除是安全、可行的。

Objective To explore the possibility and methods of surgical treatment for huge primary liver cancer. Methods A total of 106 patients with huge primary liver cancer including 98 associated with hepatic cirrhosis (mean diameter of tumors = 13 cm) were surgically treated in our hospital. Right or double subcostal incision was made and the hepatis porta was intermittently occluded at room temperature. The time for occlusion was 15-20 min and the occlusion was performed for one or two times for each patient. The first, second and third porta was dissected according to location of tumor and operative manner. Results There was no peri-operative death. Thirty-two patients with right pleural effusion, 2 with subphrenic abscess and 2 with upper digestive tract bleeding were cured by expectant treatment. The follow-up study for 2 years showed that the 1-year survival rate in the patients was 75% (79/106). Conclusions The complex treatments that mainly depend on local excision of liver are safe and acceptable for single huge primary liver cancer.