解剖性肝切除与非解剖性肝切除对肝癌预后影响的研究进展

Progress of clinical application of anatomic resection and nonanatomic resection

目前手术切除仍然是治疗肝癌的最佳手段，但人们对不同的肝癌手术切除方式对术后肿瘤复发的影响尚有争议。该文从解剖性肝切除和非解剖性肝切除的技术要点、发展历程出发，对已经发表的文献进行分析，认为肝癌肝切除手术的成功依赖于剩余肝脏储备功能和肿瘤根治性切除之间的准确平衡。单发、最大径＜2 cm的肿瘤，微血管侵犯的风险较低，解剖性肝切除与非解剖性肝切除的治疗效果相当；当肿瘤最大径为2～5 cm时，微血管侵犯的风险增加，肝功能储备较好时，解剖性肝切除的局部控制效果更好，抑制肝内转移的作用更明显，在充分保证切缘的情况下，应尽量选用解剖性肝切除术；而非解剖性肝切除术手术应激的风险较低，维持肝脏储备功能的作用更好，可应用于肝功能损伤较重的患者；对于肿瘤最大径＞5 cm、多结节性肿瘤、微血管侵犯和肝硬化较重的患者，重点是预防术后肝功能衰竭，可考虑行非解剖性肝切除术。

Currently surgical resection is still the best therapeutic method to treat hepatocellular carcinoma, but the effects of different surgical methods on postoperative recurrence of hepatocellular carcinoma are still controversial. According to the technical points and developmental course of anatomical and non-anatomical hepatectomy, this paper analyzes the published literature and draws a conclusion that success of hepatectomy depends on exact balance between residual liver reserve function and radical resection of tumor. The risk of microvascular invasion is low for solitary tumor with a maximum diameter of less than 2 cm, the results of anatomic and nonanatomic hepatic resection are comparable. When the tumor′s diameter of 2 to 5 cm in size, the risk of microvascular invasion increase, if the patients with good preserved liver function, the anatomical resection is superior to nonanatomic resection for better local control and inhibiting intrahepatic metastasis. In the full assurance of the margin cases, anatomical hepatectomy should be used. On the other hand, non-anatomical hepatectomy surgery has a lower stress risk and can maintaina better liver function reserve, which can be applied to the patients with impaired liver function. For patients with a tumor diameter more than 5 cm, multinodular tumor, microvascular invasion and severe liver cirrhosis, the focus is on the prevention of postoperative liver failure, so non-anatomic hepatectomy can be considered.