大肝癌的外科治疗策略

Surgical treatment of large hepatocellular carcinoma

全国7年制规划教材《外科学》（第1版）将肿瘤直径〉5cm且≤10cm的肝癌称为大肝癌，直径〉10cm的称为巨大肝癌。我院1999年至2003年收治6446例肝癌患者，肿瘤直径〈3cm的5年生存率达66．2％（524／792）；直径为3～5cm的5年生存率达58．2％（917／1575）；〉5cm的5年生存率为27．5％（1122／4079）。3组的5年无瘤生存率分别为39．5％（313／792）、30．1％（474／1575）、21．6％（881／4079）。

Hepatocellular carcinoma （ HCC ） with a diameter 〉 5 cm is defined as large HCC. Hepatic resection is the first choice for solitary large HCC with intact capsule and without satellite nodules. The key to successful large HCC resection is to judge the resectability and estimate the remnant liver function preoperatively. Moreover, the liver must be exposed and dissociated adequately, and familiarity with the anatomy of the liver is crucial. Choosing the right technique of hepatic blood flow occlusion and avoiding excessive resection of the liver are important elements. Special attention should be paid to the efficacy of liver transplantation for patients with large HCC exceeding Milan criteria. It is advisable to resect large HCC actively. The hepatic resection is safe and feasible in selected patients with large HCC.