原发性肝癌的手术治疗:附408例分析
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Surgical treatment of hepatocellular carcinoma:a report of 408 cases
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    摘要:

    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408例患者的临床资料。结果:408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%。408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35例,同时行肝内外胆管癌栓取栓术20例;加行全植入或药泵置入(DDS)48例(35例有门静脉癌栓者均经门静脉置入)。术后发生并发症共302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%,51.3%,35.5%。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。

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    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.

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陈菊英,吴飞跃,欧阳永忠,莫胜川.原发性肝癌的手术治疗:附408例分析[J].中国普通外科杂志,2004,13(3):1-163.
DOI:10.7659/j. issn.1005-6947.2004.03.001

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  • 在线发布日期: 2004-03-25