多结节性肝癌的手术切除(附53例分析)

Liver Surgery for Multifocal Primary Hepatocellular Carcinoma——An Analysis of 53 Cases

分析了53例多结节性肝癌手术切除的疗效。多结节性肝癌的标准为:手术探查时肝脏上存在两个或两个以上肿瘤,各肿瘤相距>3cm。本组手术方式为1.左半肝切除+右叶局切(35例),2.右半肝大部切除+左叶局切(3例),3.多处局切(15例)。术后0.5、1、2、3、5和10年生存率分别为77.4％、52.8％、27.7％、20.9％、11.4％和8.3％。有半数以上患者(26/49)术后AFP转阴。在肿瘤起源上多结节性肝癌可分为单中心及多中心起源。多中心起源者,分别切除各肿瘤可达到良好的治疗效果,少数可治愈。单中心起源至肝内播散者,疗效稍差。但不管何种起源,如能采取积极主动的治疗。包括切除加导向、免疫、化疗等综合治疗,均可延长生存期。

Hepatic resections had been performed in 53 cases of multifocal primary hepatocellular carcinoma(MPHC). MPHC was defind as: two or more nodes found in the liver and the distance between each tumor was more than 3 cm. The liver resections included:(1) left lobectomy+local resection of the right lobe, (2) partial right lobectomy+local resection of the left lobe, (3) local resections in different part of the liver. The 0.5, 1, 2, 3, 5 and 10 year survival rate after operation were 77.4％, 52.8％, 27.7％, 20.9％, 11.4％ and 8.3％ respectively. Alpha fetoprotein(AFP) levels were turned to negative in 26 of 49 cases. MPHC may be classified as multicentric origin and unicentric origin. In multicentric origin, radical resection of each tumor had a good prognosis. In patients of unicentric origin with intrahepatic disseminated nodes, the prognosis was somewhat bad. In spite of the origin, aggressive treatments including hepatic resection, targeting therapy, immunotherapy, and chemotherapy should be done to prolong the survival period.