原发性肝癌的外科治疗及临床病理学特征

Clinicopathological features and surgical treatment of primary liver cancer

  • 摘要: 目的: 综合分析以外科手术为中心的肝癌治疗的有关问题。方法: 以外科手术为中心,自 1988 至1996年综合治疗原发性肝癌223例。其中男198例,女25例,平均年龄 (49.6±10.6) 岁,HBsAg(+)163例,肝硬变189例。TNM 分期Ⅰ、Ⅱ、Ⅲ、ⅣA、ⅣB 分别为6、52、125、27、13例。病理类型为肝细胞癌207例,胆管细胞癌12例和混合癌4例。结果: 全组手术死亡率为1.8% (4/223),5年生存率为43.3%,其中瘤径 ≤ 5cm 者为54.3%,按根治情况则获病理根治 (81例)为61.7%,临床根治 (75例)为22.0%,姑息切除 (26例)为0%。获两种根治切除的156例术后1、3和5年复发率为19.8%、48.2% 和74.6%。50例肝癌术前行1~5次经导管肝动脉化疗栓塞后二期切除,5年生存率为40.5%,无瘤生存率仅为28.9%。结论: 早期发现小肝癌和大肝癌的缩小后二期切除明显提高了肝癌切除率和远期生存率,但术后复发或转移率还很高。

     

    Abstract: Objective: Clinicopathological features were considered in the surgical management of patients with primary liver cancer (PLC) with the evaluation of the outcome of liver resection. Methods: T wo hundred and twenty-three patients with PLC underwent hepatic resection as primary management for PLC from 1988to1996were retrospectively studied. 163cases of them were positive of HBsAg,189cases suffered from liver cirrhosis. TNM staging in stage Ⅰ/Ⅱ/Ⅲ/ⅣA/ⅣB were 6/52/125/27/13 cases,respectively. Histopathologic types are 207cases of hepatocellular carcinoma,12cases of cholangio-carcinoma,4cases of mixed liver carcinoma. Results: Overall operative mortality is 1. 8% (4/223),and total survival rate in 5years is 43. 3%,it is 54. 3% in group ≤ 5cm in diameter. And it is 61. 7%,22. 0% and 0% in pathologically curative resection,clinically curative resection and non-curative resection groups,respectively. Recurrence and metastasis rates in 1,3 and 5 years were 19. 8%, 48. 2% and 74. 6% in both curative resection groups. 50cases of PLC after 1~5 times TACE were sequentially resected,of which 5-year survival rate was 40. 5%. Conclusions: The resection rate of PLC is improved by early detection of small PLC and secondary resection of large PLC,and the outcome of hepatic resection are generally satisfactory;however,the recurrence and metastasis rate is still high.

     

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