600例肝切除术治疗肝癌的效果

RESULTS OF HEPATIC RESECTION FOR 600 CASES WITH PRIMARY LIVER CANCER

１９６４～１９９３年间共行肝癌切除术６００例，其中２４例为肝癌切除术后复发再次行肝切除术。男５３３例，女６７例。年龄８～７８岁，以４０～５９岁者居多。ＡＦＰ阳性率为５７．４％，合并肝硬化占８４．４％。肝细胞癌占９１．６％。肿瘤直径＜５ｃｍ者１３０例，占２１．７％。６００例中，施行规则性肝切除１０例，非规则性肝切除５９０例，包括２４例再次肝切除术。本组有２９例为肝癌自发性破裂出血后作肝切除术，其中２４例即时手术，５例作肿瘤破裂填塞止血后１６～４１天后再行肝切除术。此外，有１３例术前作ＴＡＥ后再行肝切除术，６例经剖腹探查证实不能切除后，采用多模式治疗，待肿瘤缩小后再作肝切除术。本组术后死亡２４例，手术死亡率为４．０％。死因多为肝功能衰竭和上消化道大出血。本组术后的１、３、５、１０年生存率分别为６１．９％、４０．０％、３３．０％和２９．２％。肿瘤直径≤５ｃｍ的１、３、５、１０年生存率分别为８７．８％、６９．４％、５４．０％和４３．０％。

Abstractcancer(PLC)in ourhospital from 1964 to 1993.Among them,24 cases underwent second hepatic resection because oftumor recurrence. The ratio of male to female was 8.0:1.Most of the patients were 40 to 59years old.and the age ranged from 8 to 78 years old.The positive rate of AFP was 57.4%(≥400μg/L).of them, 84.4%were associated with hepatic cirrhosis. Hepatocellular carcinoma wasverified in 91.6% of these cases. Small tumor(≤ 5cm in diameter) was found in 130 cases(21.7%).In this series,10 cases underwent semi-hepatectomy and 590 cases underwentirregular hepatectomy.Spontaneous rupture of tumor was found In 29 cases. In 13 of 600 cases,hepatectomy was done after transcatheter hepatic arterial chemoembolization. Six of 600 casesunderwent second stage hepatectomy because the tumots could not be resected duringlaparotomy. After multimodality therapy, including tumor ethanol injection treatment, microwave tumorcoagulation and hepatic artery chemoembolization, the tumors became small and Subsequentlyresected. In these 600 cases, 24 cases died within one month after hepatectomy with a mortalityof 4.0%. The most common cause of death was hepatic failure. The 1-,3-,5-,10-year survivalrates were 61. 9%, 40.2%, 33.0%, 29.2%,respectively in the whole series and 87.8%, 69.4%,54.0%, 43.0%respectively in patients with small tumor.