巨大肝癌的外科治疗分析(附72例报告)

ANALYSIS OF SURGICAL TREATMENT OF HUGE PRIMARY LIVER CANCER:A REPORT OF 72 CASES.

目的探讨外科治疗巨大肝癌的可行性及其方法。方法回顾性分析72例巨大肝癌的临床资料,并对外科治疗中遇到的主要困难和相应的对策进行分析总结。结果72例肝癌中合并门静脉、肝静脉、IVC及胆管癌栓分别为11例、1例、1例和4例。合并乙肝肝硬化68例,丙肝肝硬化和无肝硬化各2例。72例中行Ⅰ期和Ⅱ期肝切除术分别为48例和24例;其中规则性右半肝和左半肝切除术分别为10例和15例、联合肝段切除术47例。术前PVE 6例;全肝、患侧半肝血流阻断切肝术分别为5例和8例。术中行门静脉、肝静脉、IVC及胆管癌栓取出术分别为11例、1例、1例和4例。72例中治愈69例(占95.8%);围手术期死亡3例(占4.2%)。术后1年生存率达76.4%(55/72)。结论巨大肝癌的手术治疗是安全可行的。充分评估和正确应对外科治疗过程中的主要困难是取得成功的关键。

Objective To explore the possibility and methods of surgical treatment （ST） for huge primary liver cancer （HPLC）. Methods The clinical data of 72 HPLC were analyzed retrospectively and the main challenges as well as their countermeas- ures during ST are concluded. Results Among the 72 cases, there were 11,1,1, and 4 cases which complicated with portal vein （ PV）, hepatic vein （ HV）, IVC and bile duct （BD） thrombus respectively; there were 68 cases with HBV cirrhosis, 2 HCV cirrhosis and 2 without cirrhosis; there were 48 and 24 cases of primary and secondary hepatectomy in which 10/15 and 47 cases received regu-lar fight/left hemihepatectomy and combined-segmentectomy respectively. Six cases received PV embolism before surgery, and 5 and 8 cases underwent hepatectomy with whole and hemihepatic blood occlusion. There were 11,1,1, and 4 cases of cancer thrombus extraction from PV, HV, IVC and BD respectively. In this group, 69 patients were cured, and the perioperative mortality was 4.20% （3/72）. The postoperative one-year survival rate for the patients was 76. 4%. Conclusions ST for HPLC is safe and acceptable only if enough assessment and reasonable countermeasures for the challen-ges were well done.