巨大肝细胞癌的切除、复发和疗效  

Resection,recurrence and therapeutic effect of bulky hepatocellular carcinoma.

作　　者：郑光琪[1] 

机构地区：[1]华西医科大学附属一院普外科,成都610041

出　　处：《中国实用外科杂志》2000年第4期215-216,共2页Chinese Journal of Practical Surgery

摘　　要：目的　介绍用肝门区域血管阻断法切除最大径 1 0～ 30cm且经病理证实的肝细胞癌 96例的经验、复发的相关因素和疗效。方法　用肝门血管解剖法游离阻断相应血管如肝右叶或右叶多亚段切除阻断肝动脉(HA)和门静脉 (PV)右支 (5 4例次 )、中叶切除阻断HA和PV右前支和HA和PV左内支 (1 9例次 )、左叶切除阻断HA和PV左支 (1 1例次 ) ,左外段切除阻断HA和PV左外支 (1 5例次 )。结果　①手术死亡率 3 1 % ;②复发率 70 % ;③ 5年、3年、2年、1年生存率分别为 1 3 5 %、33 3%、42 8%、85 1 %。结论　本法提高了巨大肝癌的切除率和手术安全性 ,延长了中晚期病人的生存时间 ,术后经泵局部化疗 2年以防治同一细胞克隆肝癌复发 。Objective To present the experience in resection of bulky HCC by regional vascular occlusion at hepatic hilum,the factors related to recurrence and the therapeutic effect in 96 cases.Methods The correlative branches of HA and PV to the resecting hepatic lobe or segments were isolated and occluded before resection.Right branches of HA and PV were occluded for right lobectomy or multiple subsegments resection of the right lobe(54 times),right anterior and left medial branches of HA and PV occluded for middle lobe resection(19 times),left branches of HA and PV for left lobectomy and left lateral branches of HA and PV for left lateral segmentectomy(15 times).Results Operation mortality rate was 3 1%.Recurrence rate was 70 0%.and 5,3,2,1,year survival rates were 13 5%,33 3%,42 8%,85 1% respectively.Conclusion Regional vascular occlusion at hepatic hilum prolongs vascular occlusion time,increases resectability of bulky HCC,reduces blood loss and hepatocytic mass suffered from ischemia during resection,improves operation safety and living time for these very late HCC patients.Chemotherapy via HA and PV catheterization might prevent the recurrence from micrometastasis in 2 years after operation.Interferon injection probably could prevent the 2nd HCC from a new clone of hepatocytes.

关 键 词：肝细胞癌 肝门 切除术 复发 疗效 

分 类 号：R735.705[医药卫生—肿瘤]