巨大肝癌联合局部受侵犯脏器一期切除的疗效分析  

Hepatectomy combined with adjacent invaded organ(s) resection for patients with huge primary hepatic carcinoma

作　　者：索质君 缪丁丁 郑永彬 张必翔[2] 

机构地区：[1]南山区人民医院肝胆胰腺外科,广东深圳518052 [2]华中科技大学附属同济医院肝脏外科,湖北武汉430030

出　　处：《岭南现代临床外科》2016年第5期535-538,共4页Lingnan Modern Clinics in Surgery

基　　金：国家自然科学基金(81372327);深圳市南山区技术研发和创意设计项目分项基金(南科研卫2013009号)

摘　　要：目的探讨巨大肝癌联合局部受侵犯脏器一期切除的安全性及疗效。方法回顾性分析华中科技大学附属同济医院近10年收治的571例行肝切除术的巨大肝癌(肿瘤直径≥10cm)资料。术中怀疑肿瘤侵犯临近脏器而行肝癌联合局部脏器一期切除共38例,其中术后病理结果证实为转移癌17例(44.7%,转移组),其余21例为非转移癌(55.3%,非转移组),另外从533例无肝外侵犯的巨大肝癌患者中抽取100例作为对照组。结果转移组、非转移组与对照组的手术死亡率分别为5.9%、4.8%及3.0%;术后并发症的发生率分别为64.7%、66.7%和45.0%;术后第1、2、3、5年生存率分别为64.7%、41.2%、29.4%、5.9%;57.1%、38.1%、28.6%、9.5%;和65.0%、44.0%、34.0%、13.0%。经统计学分析显示三组之间的手术死亡率、并发症发生率和生存率差异均无显著性(P>0.05)。结论巨大肝癌联合局部受侵犯脏器一期切除是安全、可行的,并可获得与无肝外侵犯巨大肝癌切除相似的疗效。Objective To evaluate the safety and feasibility of hepatectomy combined with adjacent invaded organ （s） resection for the patients with large primary hepatic carcinoma （PHC）. Methods A total of 571 patients, with large PHC （≥ 10 cm in diameter） received hepatectomy, were studied retrospectively at Tongji Hospital, Huazhong University of Science and Technology. Of these patients, 38 cases underwent hepatectomy in combination with adjacent organ（s） resection because tumor invasion was suspected during operation （combined resection group）. Subsequent histological examina tion of the resected specimens provided evidence showing that 17 cases of these patients with adjacent organ （s） resection were tumor invasion （invasion group）, and the other 21 cases were non-tumor invasion （non-invasion group）. 100 patients were selected as controls from 533 patients with large PHC without extrahepatic invasion randomly. Results The operative mortality rate of combined resection group, invasion group and non-invasion group was 5.9%, 4.8% and 3.0%, respectively. The incidence of complications of these three groups after operation was 64.7%, 66.7% and 45.0%, respectively. The 1 -, 2-, 3- and 5-year survival rates of these three groups were 64.7%, 41.2%, 29.4%, 5.9% ; 57.1%, 38.1%, 28.6%, 9.5% and 65.0%, 44.0%, 34.0%, 13.0%, respectively. There were no significant differences between patients with and without extrahepatic PLC invasion on operative mortality, incidence of complication and overall survival rate. Conclusion Hepatectomy combined with adjacent invaded organ（s） resection is safe and feasible, and similar effect between patients with and without adjacent invaded organ（s） was obtained.

关 键 词：巨大肝癌 局部脏器 联合切除术 

分 类 号：R657.3[医药卫生—外科学] R735.7[医药卫生—临床医学]