原发性肝癌的外科治疗

Surgical treatment of primary liver cancer

为探讨提高肝癌外科治疗远期疗效的途径,作者报告了1988年1月～1996年12月收治的304例原发性肝癌,着重分析了223例手术切除原发性肝癌的临床、病理特点和随访结果。男198例,女25例,平均年龄49.6±10.6岁,HBsAg(+)163例,肝硬变189例。TNM 分期Ⅰ/Ⅱ/Ⅲ/ⅣA/ⅣB分别为6/52/125/27/13例。病理类型为肝细胞癌207例;胆管细胞癌12例和混合癌4例。全组手术死亡率为1.8%(4/223)。随访182例5年生存率为43.3%;其中瘤径≤5cm 者(82例)为54.3%,按根治情况则获病理根治(81例)为61.7%,临床根治(75例)分别为22.0%,姑息切除(26例)为0%。两种根治切除的156例术后1、3、5年复发率分别为19.8%、48.2%、74.6%。作者认为综合考虑多种因素选择肝癌手术方式、合理掌握肝切除量是提高手术切除率、减少并发症的重要途径。无论肿瘤大小,术后复发或转移率均很高,这是提高远期疗效亟待解决的问题。

To evaluate the recent results of liver resection in patients with primary liver cancer (PLC). Two hundred and twenty-three patients underwent hepatic resection for PLC from 1988 to 1996.163 cases were positive of HBsAG,189 cases suffered from liver cirrhosis.TNM staging in stage Ⅰ/Ⅱ/Ⅲ/ ⅣA/ⅣB were 6/52/125/27/13,respectively.Histopathologic types were of hepatocellular carcinoma in 207 cases,of cholangio-carcinoma in 12 cases,and of mixed liver carcinoma in 4 cases.Overall opera- tive mortality is 1.8%(4/223),and total survival rate(N=182) in 5 years is 43.3%,it is 54.30% in≤ 5cm group in diameter(82 cases).And it is 61.7%,22.0% and 0% in pathologically curative resection, clinically curative resection and palliative resection groups,respectively.Recurrence and metastasis rates in 1,3,5 years were 19.8%,48.2%,74.6% in the two curative resection groups.The recent results of hepatic resection for PLC are generally satisfactory;however,the recurrence and metastasis rate is still high despite the size of the tumour.