原发性肝癌731例手术治疗及围手术期处理体会

Surgical treatment and perioperative management for patients of primary liver cancer(PLC):a report of 31 cases

目的探讨提高肝癌手术治疗的安全性及疗效。方法 1990年1月至1996年12月经手术治疗原发性肝癌731例,其中肝细胞肝癌694例(94.9%),合并肝硬变占80.7%,乙型肝炎表面抗原(HBsAg)阳性占78.7%,共行肝叶切除术312例(42.7%),非切除手术419例,其中肝动脉结扎或插管置泵251例,明胶微球栓塞96例,^(32)p 玻璃微球栓塞28例,冷冻治疗24例,开腹探查取活检20例。结果肝癌切除术后1个月内病死率为2.2%,并发症发生率23.7%;术后1、3、5年生存率分别为73.1%、54.2%及34.0%。非切除手术术后1个月内病死率1.8%,并发症发生率21.8%。结论(1)氧化还原耐受试验可作为术前评价肝脏储备功能的可靠指标;(2)术中采用半肝血流阻断或区域血管阻断可减少残肝功能损伤,降低术后并发症及病死率;(3)术后采用动脉血酮体比率(AKBR)连续监测肝脏能量代谢变化,并根据 AKBR 值的变化进行强化代谢支持,有助于残肝功能迅速恢复;(4)围手术期采用中药丹参及支链氨基酸强化的静脉营养支持有助于残肝再生及肝功能衰竭的预防;(5)对不能切除的肝癌,采用冷冻合并肝动脉栓塞治疗,特别是^(32)P 玻璃微球栓塞内放射治疗可显著延长生存率。

Objective To investigate ways of enhancing safety of surgical treatment and improving survival in patients with PLC.Method Seven hundred and thirty one patients with primary liver cancer (PLC) were treated in our hospital from Jan.1990 to Dec.1996.Of those,94.9% were of hepatocellular carcinoma (HCC) and the inci- dence of cirrhosis was found in 80.7%,chronic hepatitis was in 78.8%,and AFP level above 100ng/ml was in 58.1% of all cases.Small PLC (≤5cm in diameter) was found in 7.1% of all cases,and in 19 cases the tu- mor was ≤3cm in diameter.312 patients received liver resection (42.7%).Result The mortality rate within one month after hepatectomy was 2.24%,and the complication rate was 23.7%.The 1-,3-,and 5- year survival rate was 73.1%,54.2% and 34.0%,respectively in patients undergoing hepatectomy.The surgical treatment for 419 cases of large unresectable tumor consists of hepatic artery ligation or catherterization in 251 cases,gel sponge microsphere embolization in 96 cases,radioembolization with ^(32)P-labelled glass microsphere in 28 cases,cryotherapy in 24 cases,and laporotomy and biopsy only in 20 cases.The overall mortality rate of unresection surgery was 1.8% and the postoperative complications were 21.8%.Conclusion It is concluded that:①redox tolerance test could serve as a reliable indicator of preoperative hepatic functional reserve;②hep- atopetal blood occlusion of half liver during hapatectomy can reduce the postoperative complications especially in cases with liver cirrhosis;③artery blood ketone body ratio (AKBR) could serve as a reliable parameter for the clinical evaluation of metabolic dysfunction in postoperative patients;④parenteral nutrition can enhance liver re- generation after hepatectomy;⑤Cryotherapy,hepatic artery embolization,especially radioembolization might be an important approach to improving the prognosis of patients with unresectable PLC.