原发性肝癌腹腔种植转移的诊治及预防

THE CLINIC STUDY ON ABDOMINAL CAVITY IMPLANTATION METASTASIS OF PRIMARY LIVER CANCER

目的 :探讨原发性肝癌腹腔种植转移的原因、诊断、预防措施及治疗方法。方法 :对 2 2例腹腔种植转移性肝癌的临床表现、治疗方法、首次肝切除情况和预后进行回顾性分析。结果 :全组手术治疗 2 1例 ,首次腹腔转移癌切除术后 1、3、5年生存率分别为 72 7%、2 7 3 %、13 6 % ,保守治疗 1例于肝癌术后 9个月死亡。结论 :引起腹腔种植转移的原因是癌肿生长突破肝包膜 ,肿瘤细胞脱落种植 ;肝癌自发破裂出血腹腔播散以及医源性种植。术中应彻底腹腔冲洗 ;注意“无瘤”操作 ,重视肝癌周围粘连组织的处理 ;腹腔癌细胞明显污染的病例术后定期行腹腔灌注化疗。肝癌术后定期复查能及时发现亚临床期病例。治疗上首选手术切除 ,再复发可再切除。

Objective:The purpose of this study was to consider the reason, diagnosis, prophylaxis and treatment of implantation metastasis in abdominal cavity from primary liver cancer.Methods:The retrospective analysis of clinic manifestation, treatment, initial excision of the tumor and prophylaxis of 22 cases of abdominal implantation metastasis in liver cancer was carried out.Results:21 cases were treated by surgical removal. After initial removal of implantation metastasis the survival ratio of 1, 3 and 5 years was 72 7%, 27 3% and 13 6%. One case treated conservatively was died in 9 months after liver cancer operation.Conclusion:The reasons of abdominal implantation metastasis of liver cancer were: The encapsulation was destroyed by cancer.Desquamating cells of cancer were metastasized to abdominal cavity. Dissemination of metastasis by spontaneous hemorrhage of liver cancer. Iatrgenic carcinometosis. Measures for prevention: Washing abdominal cavity thoroughly. Non-tumor technique. Attention to treatment of abdominal adhensional tissue around cancer. Contaminated with cancer in abdominal cavity the chemical drug should be perfused into cavity at regular intervals. It is necessary for follow-up examination at regular intervals in order to find subclinic patient.It is the first choice and high efficiency on surgical removal and reoperation for recurrence.