原发性肝癌的手术治疗:附408例分析

Surgical treatment of hepatocellular carcinoma:a report of 408 cases

目的 探讨原发性肝癌的手术治疗效果及影响疗效的因素。方法 回顾性分析近 8年外科手术治疗的原发性肝癌 40 8例患者的临床资料。结果 40 8例占同期原发性肝癌住院之 43 .9% ,大肝癌占 81.9% ,伴门静脉癌栓者占 8.5 % ,伴胆管癌栓者 4.8%。 40 8例中行左外叶切除 118例 ,左半肝切除 97例 ,右半肝切除 112例 ,右肝肿瘤所在区段切除 73例 ,左、右叶肿瘤同时切除 8例。同时行门静脉癌栓 (左、右支或主支 )取栓术 3 5例 ,同时行肝内外胆管癌栓取栓术 2 0例 ;加行全植入或药泵置入 (DDS) 48例 (3 5例有门静脉癌栓者均经门静脉置入 )。术后发生并发症共 3 0 2例次。包括膈下脓肿、肺部感染 ,上消化道出血 ,胸腔积液、腹水、伤口裂开等。手术死亡率 2 .7% ,残癌率为18.4% ,术后复发或转移率为 73 .0 %。 1,3 ,5年生存率分别为 73 .9% ,5 1.3 % ,3 5 .5 %。结论 原发性肝癌接受手术治疗者的病期均较晚 ,术后复发和 /或转移是影响远期疗效的主要因素。

Objective To investigate the effect of surgical treatment and the influence factors of treatment effect in patieats with hepatocellular carcinoma (HCC). Methods The clinical materials of 408 cases of HCC who underwent surgical intervention in recent 8 years were retrospectively analyzed. Results The 408 patients accounted for 43.9% of patients with HCC admitted during the same time. Of the 408 patients, large HCC accounted for 81.9% of patients, 8.5% of cases complicated by portal vein thrombus (PVT) ,and 4.8% of cases complicated by bile duct thrombus (BDT). In this series, 118 cases received left external lobectomy, 97 cases received left hemihepatectomy, 112 cases received right hemihepatectomy, 73 cases received right segmentectomy , 8 cases received left and righ segmentectomy ,35 cases received hepatectomy combining with removal of PVT , 20 cases received hepatectomy combined with thrombectomy of BDT; 48 cases received hepatectomy combined with implanment of drug delivery system (DDS) (35 patients with portal vein thrombus received DDS through portal vein). Three hundred and two cases had postoperative complications, including subdiaphragm abscesses,lung infection. upper digestive tract bleeding,pleural effusion ,ascites,wound spliting etc. Mortalily was 2.7%; cancer residual rate was 18.4%;postoperative recurrence and/or metastasis was 73.0%.The 1,3and 5-year survival rate was 73.9%,51.3%, 35.5 % respectively. Conclusions This results show that most of the patients with HCC received surgical operation treatment are in advanced stage, postoperative recurrence and/or metastasis are the main influence factors of treatment effect.