53例肝癌切除术后生存20年以上远期随访分析  

Follow-up study in 20-year survivors after resection for hepatocellular carcinoma in 53 cases

作　　者：周信达[1] 汤钊猷[1] 马曾辰[1] 樊嘉[1] 吴志全[1] 钦伦秀[1] 周俭[1] 余耀[1] 孙惠川[1] 邱双健[1] 

机构地区：[1]复旦大学附属中山医院肝癌研究所,上海200032

出　　处：《中华肝胆外科杂志》2009年第6期413-416,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的肝细胞癌（HCC）切除后生存〉20年病例文献罕见报道。笔者报道HCC切除后生存20年以上的临床和病理特点及远期随访资料。方法比较1961—1987年间长生存组（53例术后生存≥20年）和短生存组（343例术后生存〈20年）的临床和病理资料，探讨进一步提高肝癌外科远期疗效的途径。结果随访至2007年3月，53例中36例（67．9％）仍无癌生存，3例（5．7％）因肝癌复发或转移死亡，6例（11．3％）因肝功能衰竭死亡，3例（5．7％）分别死于其他疾病，5例（9．4％）失访。5例青年病人术后已结婚生育，2例肝癌破裂出血者术后分别生存26年6个月（死于肝功能衰竭）、38年9个月（健在），最长1例术后生存43年2个月，该例曾于术后38年3个月复发，经治疗后又生存4年11个月（时年94岁）。亚临床复发10例，其中再手术切除9例。复发与第一次手术间隔平均11年9个月。自第一次术后算起平均生存26年11个月。单结节肺转移3例并作再手术切除，复发与第一次手术间隔平均3年6个月，自第一次术后算起平均生存29年2个月。巨大肝癌综合治疗缩小后二期切除4例，自第一次术后算起平均生存22年10个月，均无癌生存。与短生存组比较，长生存组病人年龄较轻（P〈0．05），无症状者较多（P〈O．01）、7-GTP值低（P〈0．01）、合并肝硬化者少（P％0．01）、肿瘤直径≤5cm者多（P〈0．01）、肿瘤单结节者多（P〈0．01）、肿瘤包膜完整者多（P〈0．01）、门静脉有癌栓者少（P〈0．01）、癌细胞分化程度好（P〈0．05）、根治性切除者多（P〈0．01）。结论肝癌早期发现和根治性切除是获得长期生存的主要因素；术后长期终生随访极为重要；及早发现复发或转移并作再切除是进一步提高疗效的重要途径。Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoeellular carcinoma（HCC）. Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC. Of the 396 patients, 53（13.4%） survived ≥20 years and 343（86.6%） 〈20 years. A comparative study between the two groups was made. Results By March of 2007, 67.6% （36/53） of the patients were still alive and disease-free while 5.7% （3/53） of them died of tumor recurrence or metastasis, 11.30%（6/53） died of liver failure, 5.7%（3/53） died of other disease, and 9.4% （5/53） were lost during follow-up. Two patients with intraperitoneal rup- tured HCC survived fro 26.6 years and 38.75 years, respectively. Five young patients got married after resection and have had babies. The longest surviving time was 43 years and 2 months. Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months. Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months. Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months. In comparison with patients surviving 〈20 years, those surviving ≥20 years were significantly younger（P〈0.05） and had a higher incidence of asymptomatic tumors （P〈0.01）, lower γ-glutanyl transpeptidase levels （P〈0.01）, lower incidence of liver cirrhosis （P〈0.01） ; high- er percentage of smaller tumors （P〈0.01）, single nodule tumors （P〈0.01） and well encapsulated tumors （P〈0.01）, lower incidence of tumor emboli in portal vein （P〈0.01）, better differentiation of tumor cells （P〈0.05） and higher curative resection rate （P〈0.01）. Conclusions Early and cura- tive resection are important for improving long-term survival. Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient＇s life. Reresection fo

关 键 词：癌 肝细胞 肝切除 长生存 

分 类 号：R686[医药卫生—骨科学]