50例小肝癌外科治疗的临床分析

Clinical analysis in surgical treatment of 50 cases of small hepatocellular carcinoma

５０例小肝癌诊治表明，手术切除后复发率５７．１％（２８／４９），１年复发６０．７％（１７／２８），２年复发８５．７％（２４／２８）。２８例复发病人中，肝门型１６例，非肝门型１２例，不同类型的复发时间有显著性差异（Ｘ２＝５．２５，Ｐ＜０．０２５）。肝内复发２４例中按Ｍａｔａｓｕｍａｔａ分型：Ｉ型３例，Ⅱ型１２例，Ⅲ型９例，Ⅱ、Ⅲ型占８７．５％（２１／２４）。切除术后３年及５年生存率分别为６７％及５２％。本组资料表明门脉扩散可能是导致复发或转移的主要途径，除加强术中无瘤术，术后综合治疗包括门脉属支永久性置管，定期灌注抗癌药，或可减少复发。

This paper summarizes the experiences in the diagnosis and surgical treatment of 50 cases of small hepatocellular carcinoma.Clinical data have shown that small hepatocellular carcinoma accompanied with satellite-like nodules and portal thrombus is not uncommon.The recurrence rate after surgical resection was 57.1%(28/49),among which 61%(17/28)recurred within one year,and 86%(24/28)within two years.In 28 cases of recurrence 16 were of hepatic hilus pattern and the rest were of other patterns.There was a close relationship between the time of recurrence and the carcinoma patterns(X2=5.25,P<0.025).According to Matasumata,24 cases of intrahepatic recurrence were classified as follows:pattern I3 cases,pattern Ⅱ12 cases and pattern Ⅲ 9 cases.87.5%of the cases(21/24) were of pattern Ⅱ and Ⅲ.The three-year and five-year survival rate reached 67%and 52%respectively.The authors believe that the portal vein might be the chief route to recurrence or metastasis. Following curative resection a comprehensive treatment including a permanent drug delivery system implanted into the portal branch and regular infusion of anti-cancer drugs should be a necessary measure in reducing possible recurrence.