复发性肝癌再切除的探讨

Reoperation of Recurrent Hepatocarcinoma

目的:探讨肝癌术后复发再切除的临床价值和手术指征以及再切除方式。方法:我院自1988年至1998年对原发性肝癌施行切除术233例 ,有20例术后复发获再切除共26例次。其中伴肝硬化16例 ,占80 % ;肿瘤<5cm19例次 ,>5cm7例次 ;行肝叶切除3例 ;肝段切除7例次 ;局部切除12例次 ;肝部分切除3例次 ;右后叶切除1例。结果:无1例死亡,再切除后1～5年生存率为95 %、65 %、35 %、30 %、30 %。有1例经4次再切除已生存10年。结论:1)肝癌术后定期AFP和B超复查有助于早期发现复发。2)复发性肝癌再切除可明显提高生存率。3)复发性肝癌只要肝功能ChildA级 ,病灶局限 ,不侵犯肝门血管 ,余肝有明显代偿性增生 ,应争取再切除。4)复发性肝癌再切除的方式以局部切除或肝段切除较安全 ,尽量不做肝叶或半肝切除。

Objective: To evaluate the clinical value and probe the operative indications and reoperative mode of recurrent hepatocarcinoma. Methods: From 1988 to 1998, 233 cases of operated primary liver cancers were followed up. Second resection was performed for 26 times on 20 cases of recurrent liver cancer, 16 cases of them complicated by cirrhosis of liver (80%). The tumour sizes were< 5cm in 19 cases, >5cm in 7 cases. Left lobectomy was performed in 3 cases, segmentectomy 7 cases, local resection 12 cases, partial hepatectomy 3 cases, and right posterior lobectomy 1 case. Results: The 1-to 5-year survival rates were 95%, 65%, 35%, 30% and 30% respectively with no operative death. One patient has been alive for more than 10 years after four times of reoperation. Conclusion: 1) Postoperative periodic cheque of AFP and B-ultrasonic examination would be helpful for early discovery of recurrent liver cancer. 2) Second resection of recurrent liver cancer can markedly elevate the survival rate of the patients. 3) For the patient has the liver function of Child A grade, localized focus, without involvement of hepatic portal vessels and prominent compensatory hyperplasia of the remained liver, second resection should be strived for. 4) Local resection or segmentectomy is more suitable and it is better to avoid lobectomy or hemihepatectomy