手术切除大肝癌87例分析

Hepatectomy in 87 Cases with Large Primary Hepatocellular Carcinoma

[目的]探讨大肝癌切除的安全性和可行性。[方法]87例大肝癌病人,肿瘤平均直径10.6cm(6.8～15.5cm),采用间歇阻断入肝血流进行肝肿瘤切除,其中一期切除56例,二期切除31例,二期切除的病人术前经肝动脉和门静脉化疗栓塞治疗(TACE+PVCE),肿瘤缩小后切除。[结果]87例肿瘤均顺利切除,肝门阻断时间平均15min,出血量平均840ml,4例术后死于肝功能衰竭和上消化道出血,术后1、3、5年生存率一期切除分别为71.7%、52.1%、46.7%,二期切除分别为72.4%、57.1%、42.9%。[结论]大肝癌经综合治疗后二期切除,仍是安全可行的。

[Purpose ] To evaluate the safety and feasibility of hepatectomy for large primary hepatocellular carcinoma （ HCC ）. [ Methods ] Eighty-seven cases of HCC with a mean diameter of 10.6cm （6,8-15.5cm） were treated with hepatectomy under intermittent occlusion of hepatic inflow. Of the 87 cases, 56 cases underwent one-stage resection; and 31 cases two-stage resection after transcatheter hepatic arterial chemoembolization （TACE） and transportal venous chemoembolization （PVCE）. [Results] Hepatectomy was successfully performed in all the 87 cases. The mean time of hepatic inflow occlusion was 15min and the mean blood loss was 840ml. Four cases died of postoperative hepatic function failure and upper gastrointestinal hemorrhage postoperatively in this series. The 1-, 3-, 5-year survival rates were 71.7%, 52.1%, 46.7% after one-stage resection and 72.4%, 57.1%, 42.9% after two-stage resection respectively. [ Conclusion] Two-stage resection is safe and feasible after multi-modality therapy in large HCC.