原发性肝癌的综合治疗——附607例报告

Comprehensive Therapy for Primary Liver Cancer:A Report of 607 Cases

背景与目的:虽然原发性肝癌(简称肝癌)的早期诊断和早期治疗取得了很大进步,但大多数为合并有肝硬化的中晚期肝癌患者,手术切除并非适合所有肝癌患者,即使能切除,术后复发率也高达60%以上,因而,肝癌的整体治疗效果较差。本研究探讨肝癌的综合治疗方法,以进一步提高肝癌的整体治疗效果。方法:回顾性分析我科以外科为主综合治疗的607例肝癌患者的病例资料,其中,手术切除共423例,行不规则性肝叶切除134例,局部切除95例,肝叶或肝段切除123例,半肝或半肝以上切除共54例,联合脏器切除17例;手术不能切除184例,行肝固有动脉结扎联合肝动脉及门静脉双插管化疗或瘤体内注射无水乙醇或冷冻、射频治疗、微波固化、腹腔化疗等。结果:总的手术切除率69.7%(423/607),手术死亡率1.2%(5/423);全组3、5、10年生存率分别为42.7%(218/511)、37.5%(123/328)和26.5%(26/98);切除组3、5、10年生存率分别为57.2%(203/355)、51.3%(118/230)和35.3%(24/68);不能切除组3、5、10年生存率分别为9.6%(15/156)、5.1%(5/98)和6.7%(2/30)。结论:以外科为主的综合治疗是目前可切除肝癌较好的治疗方法。术后个体化综合治疗可提高肝癌的手术治疗效果。

BACKGROUND &OBJECTIVE: Progress has been made in the field of early detection and early treatment of primary liver cancer (PLC),but many PLC patients remain unresectable, because their tumors are advanced or coexist with liver cirrhosis. Even if the tumor can be resected, the recurrent rate is more than 60%. This study aimed to investigate the efficacy of comprehensive therapy of PLC to improve the outcome. METHODS: A retrospective analysis of 607 patients with PLC received comprehensive treatment in Affiliated Tumor Hospital,Guangxi Medical University from 1985 to 2001. Among them,423 cases were treated with various modes of hepatectomy:134 with irregular hepatectomy, 95 with local radical resection,123 with regular liver lobectomy or liver segment resection, 54 with semi hepatectomy or more, 17 with hepatectomy combined with section of other organ. The other 184 nonresectable cases were treated with various combinations of therapy, such as ligation of hepatic artery, microwave coagulation, inter tumor injection of ethanol, cryosurgery, radio frequency (RF), and intraperitoneal chemotherapy. RESULTS: 69.7%(423/607) of the whole group received liver resection, the overall mortality rate within one month after operation was 1.2%(5/423),and the 3 , 5 ,10 year survival rates were 42.7%(218/511),37.5%(123/328),and 26.5%(26/98),respectively. For the resection group,the 3 ,5 ,10 year survival rates were 57.2%(203/355),51.3%(118/230), and 35.3%(24/68), respectively. For the nonresectable group, the 3 ,5 ,10 year survival rates were 9.6%(15/156), 5.1%(5/98), and 6.7%(2/30),respectively. CONCLUSION: Surgery predominant comprehensive therapy is effective modality for resectable PLC. Postoperative individualized comprehensive treatment can prevent tumor recurrence and improve postoperative effect.