手术切除347例原发性肝癌的临床分析

Clinical analysis of 347 patients undergoing hepatectomy of primary liver cancer

目的:探讨347例原发性肝癌手术切除的临床疗效及其影响因素。方法:对347例手术切除的原发性肝癌患者的临床资料和随访结果进行分析。结果:原发性肝癌手术切除的并发症发生率为6.34%(22/347),围手术期死亡率为1.15%(4/347)。术后1、3和5年总生存率分别为87.96%、48.47%和22.82%。肿瘤直径<3cm的患者,其术后1、3和5年生存率分别为95.24%、83.33%和75.00%。肿瘤大小与术后1年生存率无明显相关性(P>0.05),但肿瘤直径>5cm患者的术后3和5年生存率分别为41.88%和17.05%,明显低于肿瘤直径≤5cm患者的77.78%和60.00%(P=0.000)。结论:合理掌握原发性肝癌切除适应证以及根据肿瘤大小确定切缘距离能够降低并发症和围手术期死亡率,并提高生存率。定期监测原发性肝癌高危人群能够提高小肝癌的检出率。此外,术中B超能够有效定位小肝癌,甲胎蛋白是原发性肝癌完整切除和复发转移的敏感指标。

Objective：To evaluate the clinical efficacy of hepatectomy for 347 patients with primary liver cancer.Methods：Clinical and follow-up data from 347 patients undergoing liver resection for primary liver cancer were retrospectively reviewed.Results：The incidence of postoperative complications was 6.34%（22/347）,and the perioperative mortality was 1.15%（4/347）.The overall one-year,three-year and five-year survival rates were 87.96%,48.47% and 22.82%,respectively.In patients with tumor smaller than 3 cm,one-year,three-year and five-year survival rates were 95.24%,88.33% and 75.00%,respectively.There was no significant correlation between tumor size and one-year survival rate（P〉0.05）.However,three-year（41.88%）and five-year survival rate（17.05%）in patients with tumor size〉5 cm were significantly lower than those in patients with tumor size≤5 cm（77.78% and 60.00%,respectively,P=0.000）.Conclusion：To ensure appropriate indication selection and the safety distance between the tumor and the resection margin may decrease postoperative complication incidence and the perioperative mortality,as well as improve the survival rates.Regular surveillance for population with high risk of primary liver cancer can increase the detection rate of small primary liver cancer.Furthermore,application of intraoperative ultrasound positioning system can detect small primary liver cancer more accurately.Alpha feto-protein is considered as a sensitive marker for predicting margin-negative/positive resection and the recurrence of primary liver cancer.