30例特殊部位小肝癌的外科治疗

Analysis of surgical treatment of 30 cases of small hepatocellular carcinoma in special position

目的 探讨特殊部位小肝癌外科手术治疗的方法和疗效.方法 回顾性分析行手术治疗的30例特殊部位小肝癌患者的临床和随访资料.30例患者中,肝细胞癌29例,胆管细胞癌1例;肿瘤邻近第一肝门8例,邻近第二肝门15例,邻近第三肝门7例;单发病灶25例,双原发灶4例,三原发灶1例.肿瘤直径（2.7±1.2）cm.结果 30例患者手术均获成功,无围手术期死亡.手术时间（279±101）min,术中出血量200～2000 ml,平均566 ml,术后住院时间（10.5±2.7）d.术后1、3年生存率分别为100%和83.3%,1、3年无瘤生存率分别为85.0%和41.3%.结论 特殊部位小肝癌的手术难度大,但做好围手术期处理,手术是安全可行的,是特殊部位小肝癌的有效治疗方法.

Objective To investigate the resection technique for small hepatocellular carcinoma （SHCC） in special sites and discuss their outcome. Methods Clinicopathological data of 30 patients with SHCC in special sites undergone liver resection were reviewed. There were 29 cases of hepatocellularcarcinoma and 1 case of cholangiocarcinoma, confirmed by pathology. The tumor was close to the first porta hepatis in 8 cases,colse to the second porta hepatis in 15 cases, and close to the third porta hepatis in 7 cases. Twenty-five patients had one lesion, 4 patients had two and the other had three. The tumor diameter was （2.7 ± 1.2） cm. Results No perioperative death occurred. The operation time was （ 279±101 ） min,the mean intraoperative blood loss was 566 ml, and the postoperative hospitalization was （10.5 ±2.7） days. The 1- and 3-year survival rates were 100% and 83.3%, respectively,and the 1-and 3-year disease free survival rates were 85.0% and 41.3%, respectively.Conclusion Although the surgery for SHCC in special sites is quite difficult and risky, surgical treatment is still safe with good perioperative management and is an effective treatment of SHCC in special sites.