以外科手术为主综合治疗小肝癌134例临床报告

Surgery Predominant Comprehensive Therapy for 134 Patients with Small Hepatocellular Carcinoma

背景与目的:手术切除是治疗小肝癌的首选方法,但术后5年复发率高达35.4%～45.3%,是影响手术疗效的关键因素。本研究拟探讨以外科为主的综合治疗来降低小肝癌术后复发率。方法:以外科为主综合治疗小肝癌(直径≤5cm)患者134例,男119例,女15例,年龄18～70岁,中位年龄45岁;手术切除(切除组)121例,其中,不规则性肝叶切除16例,局部切除83例,肝叶或肝段切除12例,左半肝切除2例,联合胆囊切除8例;切除后切缘注射无水酒精或用渗入无水酒精的明胶海绵包埋于瘤床共22例。手术不能切除13例,行肝固有动脉结扎合并肝动脉及门静脉双插管化疗或瘤体内注射无水酒精或冷冻、射频治疗、微波固化、栓塞化疗等。结果:小肝癌手术切除率90.3%,无手术死亡。切除组术后1、3、5、10年生存率分别为89.3%、74.4%、64.6%和43.8%;术后1、3、5年复发率分别为11.9%、23.8%和32.1%。全组1、3、5、10年生存率分别为88.8%、72.2%、63.4%和41.7%;1、3、5年复发率分别为15.9%、29.1%和36.6%。结论:手术切除是治疗小肝癌的有效方法,以个体化为原则外科为主的综合治疗可降低术后复发率,提高小肝癌治疗效果。

BACKGROUND & OBJECTIVE:Although surgical resection is the primary choice modality in treatment of small hepatocellular carcinoma(HCC),the 5 year recurrent rate after resection was as high as 35 4%～43 5%. This study was designed to investigate the efficacy of surgery predominant comprehensive therapy for small HCC in reducing the recurrent rate and improving the outcome. METHODS:A total of 134 cases of small HCC (≤5 cm in diameter) received surgery predominant comprehensive treatment in The Affiliated Tumor Hospital, Guangxi Medical University from 1985 to 2001. The median age of the patients was 45 years old (range,18-70 years). Of 134 cases, 121 were treated with hepatectomy: 16 with irregular hepatectomy, 83 with local radical resection,12 with regular liver lobe resection or liver segment resection, 2 with left semi hepatectomy, and 8 with hepatectomy and gallbladder resection. In the other 13 cases of nonresectable small HCC, they received multimodality treatments by various combinations of hepatic artery ligation and anticancer agents by hepatic artery infusion, microwave coagulation, ethanol injection into tumor,cryosurgery,radio frequency (RF),and hepatic artery chemoembolization therapy.RESULTS:Of 134 HCC patients, 90 3% received liver resection and no operative death occurred. For the surgery group, the 1 , 3 , 5 , and 10 year survival rates were 89 3%,74 4%,64 6%,and 43 8%,respectively; the 1 , 3 ,and 5 year recurrent rates were 11 9%,23 8%,and 32 1%,respectively. For the total group,the 1 ,3 ,5 ,and 10 year survival rates were 88 8%,72 2%,63 4%,and 41 7%,respectively;the 1 ,3 ,and 5 year recurrent rates were 15 9%,29 1%,and 36 6%,respectively. CONCLUSIONS:Surgical resection remains primary choice modality in treatment of small HCC; postoperative comprehensive treatment is important for preventing tumor recurrence and improving the long term results.