肝癌根治术后肝内复发合并肝外转移积极手术治疗10例

Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma: an analysis of 10 cases

目的:探讨对严格选择的肝癌根治术后肝内复发并肝外转移患者采取积极外科治疗策略的临床价值.方法:回顾性分析10例肝癌根治术后肝内复发伴肝外孤立转移灶病例的外科治疗情况.并与行保守治疗的肝癌根治术后肝内复发伴肝外转移的48例患者的生存情况进行比较.结果:Kaplan-Meier生存分析显示积极外科治疗组复发后中位生存时间为45.0mo±5.1mo,保守治疗组复发后中位生存时间仅为12.0mo±2.1mo.Log-rank检验对两组生存时间比较,发现积极手术治疗组生存时间显著长于保守治疗组(P<0.01)结论:对于严格选择的病例采取肝外孤立转移灶切除联合肝内复发灶切除或局部治疗的积极外科治疗策略能够显著提高患者生存时间.

AIM： To evaluate the value of combined resection and locoregional therapy in the management of selected patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma. METHODS： The clinical data for 10 patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma who underwent resection of extrahepatic recurrence and reresection or locoregional therapy for intrahepatic recurrence were analyzed retrospectively. The survival of these 10 patients was compared with other 48 patients whose extrahepatic and intrahepatic recurrences were treated by nonsurgical means.RESULTS： The median survival after recurrences in 10 patients undergoing surgical treatment was significantly higher than that in the other 48 patients with extrahepatic and intrahepatic recurrences treated by nonsurgical means （45.0 mo± 5.1 mo vs 12. 0 mo ± 2.1 mo, P 〈 0.01）. CONCLUSION： Combined resection of isolated extrahepatic recurrence and re-resection or locoregional therapy for intrahepatic recurrences may offer long-term survival in patients who develop both intrahepatic and extrahepatic recurrences after hepatectomy for HCC.