原发性肝癌的外科治疗

Surgicaltreatmentofprimarylivercancer

作者报告了１９６０年～１９９３年经手术切除原发性肝癌２０５１例，其中肝细胞癌占９４．１％；合并肝硬变或慢性肝炎者占８６．５％。肿瘤直径≤５ｃｍ者占２５．１％，其中≤３ｃｍ者１７６例。４４．０％为局部根治性肝切除。手术后１个月内死亡率为１．１％。全组术后５年生存率为３６．１％；肿瘤≤５ｃｍ者，无手术死亡，术后５年生存率为７９．８％；而肿瘤≤３ｃｍ者，术后５年生存率８５．３％。作者认为，以下几点对提高肝癌手术疗效极为重要：（１）早期诊断、早期切除仍然是提高肝癌疗效的关键。５１５例小肝癌手术切除率达９２．６％，无手术后死亡，术后５年生存率达７９．８％，而１７６例≤３ｃｍ者术后５年生存率高达８５．３％。（２）改进手术方法对降低手术死亡率、减少术后并发症、提高手术疗效极为重要。本组１９７７年前手术死亡率为８．８％，而８０年代后降至０．３％，总死亡率仅１．１％。（３）术后复发的及时处理也是提高疗效的重要措施。本组有９５例术后复发进行２０６次手术，首次、二次术后５年生存率分别为５３．２％和２５．０％，最长１例已健存１８年。（４）对不能切除的大肝癌经各种方法治疗使肿瘤缩小后再行二期切除，也是提高疗效的积极措施。作者１９７４?

Themortalityrateofpatientswithprimarylivercancer(PLC)was20.40per100,000Chineseperyear,thattakesthesecondplaceamongalformsofcancer.SurgicalresectionremainsthemodalityofprimarychoiceinthetreatmentofPLC.2051patientswithPLCweretreatedbyliverresec-tionfrom1960to1993.Ofthose,94.1%werehepatocelularcarcinoma(HCC)andtheincidenceofcir-rhosisandchronichepatitiswasfoundin86.5%.SmalPLC(≤5cmindiameter)wasfoundin25.1%ofalcases.InthesmalPLCgroup,176caseswerefoundthetumor≤3cmindiameter.Al2051patientsreceivedliverresectionand44.0%ofthemhadlocalradicalresection.Theoveralmortalityratewithinonemonthafteroperationwas1.1%.Theoveral5-yearsurvivalratewas36.1%.Improvedsurgicalre-sultwasobtainedin515patientswithsmalPLC(≤5cmindiameter).Nooperativedeathocurredinthisgroupandthe5-yearsurvivalratewas79.8%.Moreover,thepatientswithverysmalPLC(≤3cmindiameter)prolongaedtheirsurvival.The5-yearsurvivalratewas85.3%.EarlydiagnosisandearlyresectionofPLCareoneofthekeypointsforimprovingthelong-termresults.Improvementsinopera-tivetechniquesplayanimportantroleinreducingpost-operativecomplications,loweringoperativemor-talityandobtainngbeteroperativeresults.Rehepatectomyforrecurentlivercancercanimprovethesurgicalresults.95patientsunderwentrehepatectomywitha5-yearsurvivalrateof53.2%and25.0%afterthefirstandsecondoperationrespectively.Onepatientsurvived18years.Forunresectablelargetumors,two-stageresectioncanbeused.Wecolected659casesoflargeunresectabletumorsfrom1974to1994.Amongthem,73caseswereresectedintwo-stageoperation.Theresectionratewas11.1%,andthe5-yearsurvivalratewas61.5%.Postoperativecomprehensivetreatmentisalsoimportantforupregulatingcelularimmunologicalfunction,preventingtumorrecurence,andimprovingsurgicalre-sults.