原发性肝癌不同根治性切除术标准的评价  

Evaluation of Different Criterias of Curative Resection for Primary Liver Cancer

作　　者：黄力文[1] 马曾辰[1] 林芷英[1] 汤钊猷[1] 钦伦秀[1] 叶青海[1] 孙惠川[1] 黄晓武[1] 

机构地区：[1]复旦大学附属中山医院复旦大学肝癌研究所,上海200032

出　　处：《中国临床医学》2001年第4期336-338,共3页Chinese Journal of Clinical Medicine

摘　　要：目的 :评价原发性肝癌 (PLC) 3种根治性切除术标准的临床意义。方法 :将各种标准归纳为 3种 :术中单项标准 (A) :完整切除肉眼所见肿瘤 ,术中多项标准 (B) :在A的基础上增加①无主要管道癌栓②肿瘤数目不超过 2个③无肝外转移 ,术后综合标准 (C) :在B的基础上增加术后 2个月内AFP降至正常和影像学检查无肿瘤残存。对 2 2 2例PLC肝切除患者按 3个标准分组 ,比较各标准根治组生存率 (OS)及无瘤生存率 (DFS)间差别。结果 :A、B、C根治组的 3年OS5 8.5 %、72 .1%和 91.6 % ,3年DFS36 .4%、44 .0 %和 5 6 .4%。A、B根治组OS、DFS间差别有统计学意义 (P <0 .0 5 ) ,C、B根治组两者之间差别有高度统计学意义 (P <0 .0 1)。结论 :根据多项条件的术中根治标准较单项标准更为合理。Objective: To evaluate three different criterias of curative resection for primary liver cancer (PLC). Methods: Various criterias of curative resection were summed up as three kinds in this paper. They were ①intraoperative monomial criteria(A),which meant the removal of all gross tumors, ②intraopera tive multinomial criteria (B), which based on Criteria A requied the lack of extrahepatic metastases, multiplicity (>2) of the tumors and thromboses in the main trunks of the liver, ③ postoperative combined criteria (C), which should be even confirmed by a negative follow-up result with serology and imagining techniques within two months after a Criteria-B-curative resection. 222 cases with hepatic resections for PLC were divided into groups according to these criterias. Statistical differences of the overall-survival rates (OS) and disease-free survival rates (DFS) of three curative groups were tested by Log-rank method. Results: The 3-year OS of curative groups of Criteria A, B and C were 58.5%, 72.1% and 91.6%, while 3-year DFS were 36.4%, 44.0% and 56.4% respectively. Statistical differences of OS and DFS were shown between curative groups A and B ( P <0.05), while highly statistical differences between curative groups B and C ( P <0.01). Conclusions: It is more reasonable to use intraoperative multinomial criteria as the indication of curative resection comparing with monomial criteria. Postoperative combined criteria will be more credible for evaluating the curability of the operation.

关 键 词：原发性肝癌 肝切除术 根治性标准 PLC 

分 类 号：R735.7[医药卫生—肿瘤] R730.56[医药卫生—临床医学]