从小肝癌的复发探讨合理的手术方式

Rational surgical approaches to the treatment of smallprimary liver cancer ,and the prevention of postopera-tive recurrence

从１９８５年９月～１９９０年１２月，我院手术治疗小肝癌２７例，其中施行肝段切除２３例，局部切除４例。术后肿瘤复发率为６６．７％（１８／２７），复发灶均不在切缘上。作者认为：（１）肝癌手术后有较高的复发率，早期发现亚临床复发灶，及时治疗仍是提高生存率的重要途径。（２）ＡＦＰ、Ｂ超、胸片应视为术后复查的基本方法。数字减影肝血管造影能较正确地显示肝内复发灶，需再次手术的病例，应作该项检查。（３）小肝癌复发后，最理想的治疗是再次手术切除。本组再手术率５５．６％（１０／１８）。再次切除宜行肝局部切除。（４）小肝癌首次手术方式，宜行肝段切除或棍治性局部切除。

AbstractFrom Sep. 1985 to Dec. 1990,surgical treatmentwas performed in 27 patients with small primary livercancer(SPLC,≤5cm in diameter). Of them , segmen-tectomy was done in 23 cases and radical local resectionin 4 cases with recurrence rate of 66. 77%(18/27).Non recurrent lesions were located in the incisal mar-gin. In this group re-resection rate was 55.6%(10/18).(1)Early detection and treatment of recurrent le-sions remain a mainstay of prolonging survival.(2)Serum Alpha-fetoprotein(AFP),ultrasonography andX-ray chest film were basic follow-up methods for sub-clinical recurrence of SPLC. For re-operation cases,digital subtract angiography(DSA) are useful in identi-fying subclinical lesions.(3)For recurrent liver cancerlocal hepatectomy was a reasonable approach.(4) ForSPLC , radical segmentectomy or radical local resectionwith a safe margin of 1 to 2cm was the authors’choice.