原发性肝癌手术后种植灶的治疗

Surgical treatment of implanted metastases of primary liver cancer after initial hepatectomy

目的 :探讨原发性肝癌术后种植性转移的发生和治疗。方法 :分析 35例原发性肝癌手术后腹腔和 (或 )腹壁种植性转移患者的临床特征、治疗方式及预后。结果 :肝癌手术后种植性转移发生率为 1.0 3% ,再次手术率为 94.2 9% ,首次肝癌切除术后 1年、2年和 3年的生存率分别是 90 .5 2 %、6 6 .79%和 40 .2 0 % ,平均生存期为 38.2 8个月 ,中位生存期为 32个月 ;种植灶切除术后 1年、2年和 3年的生存率分别是 70 .6 0 %、48.0 6 %和 2 9.6 3% ,平均生存期为 2 9.5 9个月 ,中位生存期为 2 4个月。结论 :肝癌术后种植性转移与包膜侵犯、肿瘤破裂、相对根治性手术、肿瘤侵犯程度以及围手术期输血密切相关。及时行手术切除治疗 ,可延长生存期 ,甚至达到治愈的疗效。

Objective:To investigate the incidence of implanted metastases of primary liver cancer after initial hepatectomy, and to evaluate the result of surgical treatment.Methods:From January 1995 to December 1999, 35 patients had implanted metastases after initial hepatectomy. Their clinical characteristics, treatment, and prognosis were reviewed.Results:The incidence of implanted metastases was 1.03%, and 33 cases underwent resection. The 1 year, 2 year and 3 year survival rate were 70.60%?48.06% and 29.63% respectively, with the median survival time of 29.59 months and the average survival time of 24 months.Conclusion:The significant factors correlated with implanted metastases involve ruptured cancer, capsule involved, relatively radical operation, the extent of invaded and perioperative blood transfusion. Resection of the implanted tumor can improve the long term results.