原发性肝癌的外科治疗——附5524例报告

Surgical treatment of primary liver cancer: report of 5?524 cases

目的 探讨原发性肝癌的外科治疗效果。 方法 196 0年 1月至 1998年 12月共施行原发性肝癌肝切除术 5 5 2 4例。比较 196 0年～ 1977年 (181例 )、1978年～ 1989年 (92 1例 )、1990年～1998年 (4 42 2例 ) 3个阶段肝癌治疗的效果。 结果 3个阶段术后 1个月内住院病死率分别为8 48%、0 43 %、0 31% ,而 5年生存率分别为 16 0 %、30 6 %和 48 6 %。结果表明 ,以常温下间歇肝门阻断 ,指捏加钳夹法切肝 ,大血管损伤的妥善处理和局部根治性肝切除为标志的肝脏外科技术 ,在肝癌外科技术中具有普遍的实用价值。 结论 早期肿瘤切除、术前肝动脉插管化疗栓塞、术中无瘤技术、术后综合治疗、以及肿瘤复发再切除可显著延长患者无瘤生存期 ,降低肝癌复发的危害性。二期切除可使中晚期肝癌患者重获手术切除机会 ,但并非适用于所有大肝癌 ,对肝癌的可切除性要有一个准确的判断。

Objective To study the results of surgical treatment of patients with primary liver cancer. [WT5”HZ]Methods[WT5”BZ] From January 1960 to December 1998, 5?524 patients with pathologically proven primary liver cancer (PLC) underwent hepatectomy.Their results were compared in 3 periods: 1960 1977 (181 patients),1978 1989(921), and 1990 1998(4?422). [WT5”HZ]Results[WT5”BZ] Surgical outcomes were improved gradully as shown by the five year survival rate of 16 0% for the period of 1960 1997, 30 6% for 1978 1989, and 48 6% for 1990 1998. The operative mortality rate was in a decreased order from 8 48%, 0 43% to 0 31% during the three periods. These data indicated the progress in clinical research of PLC and the importance of surgery. Normothemic intermittent interruption of the porta hepatis, transection with finger fracture and forceps, radical local resection and management of huge tumor involving the porta hepatis and IVC were the main approaches in our practice. [WT5”HZ]Conclusions[WT5”BZ] Postoperative recurrence remains to be a problem. Tumor free survival, however, could be increased by early detection and resection, preoperative TACE, no iatrogenic dissemination, postoperative comprehensive treatment, and reoperation. Two stage operation is only indicated for unresectable PLC but not for large tumors involved the porta hepatis or IVC. The resectability should be judged carefully.