手术切除联合术后TACE治疗中晚期肝癌198例报告

Hepatectomy in Combination with Postoperative TACE for Patients with Progressive and Advanced HCC(A Report of 198 Cases)

目的总结中晚期原发性肝癌手术切除联合术后TACE的治疗效果。方法回顾性分析1998年10月-2004年12月手术切除中晚期肝癌198例临床资料,154例（77.8%）有乙肝背景,148例（74.7%）合并肝硬化,术前AFP阳性182例（91.9%）,肿瘤直径6-10 cm 120例（60.6%）,10-15 cm 48例（24.2%）,15-20 cm 30例（15.2%）,包膜完整者186例（93.9%）;肿瘤位于左肝59例（29.8%）,右肝119例（60.1%）,中肝叶20例（10.1%）,实施肝段切除139例（70.2%）,左半肝切除18例（9.1%）,右半肝切除30例（15.2%）,中肝叶切除11例（5.6%）,分别于手术后1月、2月、3月、6月、9月、12月、18月、24月行TACE,动态检测患者AFP变化,复查上腹CT。结果围术期死亡5例,术后AFP转阴者162例（81.8%）;术后1年、3年、5年生存率分别为96.3%,56.8%,33.8%。结论手术切除联合术后TACE可以有效提高中晚期肝癌生存率并改善生存质量。

Objective To conclude the therapeutic efficacy of hepatectomy in combination with postoperative TACE for patients with progressive and advanced HCC. Methods Clinical data of 198 cases suffered from progressive and advanced HCC between Oct. 1998 to Dec. 2004 was analyzed retrospectively. In all the cases, 154（77.8% ） had hepatitis B background , 148 （74.7%） had hepatic cirrhosis, 182（91.9% ） were AFP positive, 120 （60.6%）with tumor diameter of 6 - 10 cm ,48 （24.2%）of 10 - 15 cm, and 30 （ 15.2% ）of 15 -20 cm. 186（93.9% ） had complete tumor amicula. The tumor located in left liver of 59 （29.8%）, in right liver of 119（60.1% ） ,and in the medial segment of 20（ 10.1% ）. The patients underwent regional hepatectomy of 139 （70.2%） ,left liver lobetectomy of 18 （9.1% ）, and right lobetectmomy of 30 （ 15.2% ）, and medial segment hepatectomy of 11 （5.6%）. All the cases were performed with TACE 1,2,3,6,9,12,18,24 months after operation. AFP and upper abdominal CT were evaluated dynamically. Result 5 cases died pe- rioperatively. 162（81.8% ） cases turned to AFP negative. The 1-,3-,5-year survival rate was 96.3% ,56.8% and 33.8% respectively. Conclusion Hepatectomy in combination with postoperative TACE can effectively improve the survival and life quality for patients suffering from progressive and advanced HCC.