105例小肝癌手术治疗经验及预后分析

SURGICAL TREATMENT AND PROGNOSTIC ANALYSIS OF 105 CASES WITH SMALL HEPATOCELLULAR CARCINOMA

目的探讨影响小肝癌手术后生存率的临床病理因素。方法回顾性分析1986.1-2006.6月手术切除并获得随访的105例小肝癌（≤3 cm）的临床病理资料,中位随访时间33个月。对有无结节性肝硬化、肝功能Ch ild分级、术前血清AFP水平、肿瘤大小、有无肿瘤包膜、肿瘤分化程度（Edmondson分级）、有无门脉癌栓、是否多灶性（包括卫星灶）及手术方式等与术后生存率的关系进行分析。结果截止2006年12月,随访105例,失访5例,手术后1、3、5年生存率分别为86.5%、70.3%、55.2%,无瘤生存率分别为78%、58.9%、45.6%。再次手术死亡1例。随访期内36例肝内复发,34例死亡。分析提示术前肝功能Ch ild分级、肿瘤大小、门静脉癌栓及多灶性是影响手术后生存率的预后因素。结论距肿瘤1 cm以上切缘的局部肝脏切除是治疗小肝癌的合理手术方式,手术后的肝内复发和转移是导致小肝癌病人术后死亡的主要原因。

Objective To analyze the clinicopathologic factors that can influence the postoperative survival in patients with small hepatocellular carcinoma. Methods The clinicopathologic data of 105 cases of surgically resected small HCC between 1986 and 2006 were analyzed, all of which had been followed up for median 33 months. Clinicopathologic factors including preoperative α-feto protein level, liver cirrhosis, Child-Pugh score, tumor size and number （ single vs. multiple）, capsule formation, portal vein tumor thrombi （PVTr）, Edmondson tumor grade and surgical method were analyzed. Results Up to 2006 Postoperatively, the survival rate of 1,3 and 5-year were 86. 5% ,70. 3% and 55.2% respectively, and the disease free survival rate of 1,3 and 5-year were 78. 0%, 58.9% and 45. 6% respectively. One patient died after re -operation. Up to the time of following up, 36 had intrahepatic recurrence postoperatively. 34 patients died and statistical analysis indicated that poor Child-Pugh score, tumor size, PvTr and multiple lesions were adverse factors affecting postoperative survival. Conclusions Limited hepatectomy with a margin no less than 1 cm is an appropriate surgical approach. Postoperative intrahepatic recurrences or metastasis is the main factor leading to the death of patients with small HCC.