原发性肝脏肉瘤的诊断及外科治疗  

Primary liver sarcoma： diagnosis and surgical treatment

作　　者：周锋[1] 韩少良[1] 陈茂松[2] 黄瀚章 杜舟[1] 王鹏飞[1] 章晓东[1] 

机构地区：[1]温州医科大学附属第一医院普外科,浙江325000 [2]海口海南省肿瘤医院胃肠外科,570100

出　　处：《中华肝胆外科杂志》2016年第11期746-748,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨原发性肝脏肉瘤的诊断及外科治疗，提高临床诊疗水平。方法回顾性分析2001年1月至2016年5月17例原发性肝肉瘤患者诊断、治疗及预后资料。结果17例原发性肝肉瘤患者术前AFP升高1例（5．9％）、HBsAg阳性3例（17．6％）、CEA升高2例（11．8％）、肝脏功能异常3例（17．6％）。主要临床症状包括上腹隐痛9例、上腹胀满7例、食欲减退4例及胃癌术后随诊时发现1例。17例原发性肝肉瘤中12例手术切除，切除率为64．7％（11／17）。其中R0切除10例，R1切除2例，剖腹探查活检术5例。术后5例辅助选择性肝动脉灌注化疗（丝裂霉素＋氟尿嘧啶＋表阿霉素），4例辅助全身化疗（长春新碱、顺铂、环磷酰胺、阿霉素）。全组病例1、3、5年生存率分别为58．8％（10／17）、29．4％（5／17）及11．7％（2／17）。接受肝切除术患者1、3、5年生存率分别为83．3％（10／12）、41．6％（5／12）及16．7％（2／12），R0切除的患者分别为100％（10／10）、50．0％（5／10）及20．0％（2／10）。结论原发性肝肉瘤术前确诊很难，但根治性切除及术后辅助化疗可获得较良好生存率。Objective To study the diagnosis and surgical treatment of primary sarcoma of liver in order to obtain a better understanding of this disease and to improve its clinical treatment. Methods The clinical data on the clinicopathological features, surgical treatments and prognosis of 17 patients with primary liver sarcoma who were treated from January 2001 to May 2016 were retrospectively analyzed. Results Of 17 patients with primary sarcoma of liver, elevation of preoperative serum AFP was detected in one patient （5.9%）, HBsAg positivity in 3 patients （ 17.6% ）, elevation of CEA in 2 patients （ 11.8% ） and abnormal liver function in 3 patients （ 17.6% ）. The main clinical symptoms included epigastric pain in 9 patients, epigastric distention in 7 patients, loss of appetite in 5 patients （ including in one patient after resection of gastric carcinoma）. Twelve of these 17 patients underwent resection （resection rate 64.7% ）. Five patients underwent laparotomy and biopsy. Among patients who were treated with surgical resection, 10 patients had R0 resection and 2 patients had R1 resection. Postoperatively, 5 of these patients underwent adjuvant selec- tive hepatic arterial infusion chemotherapy （ mitomycin ＋ fluorouracil ＋ epirubicin）, and 4 patients were trea- ted with adjuvant systemic chemotherapy （vincristin, cisplatin, cyclophosphamide and Doxorubicin）. The postoperative 1, 3 and 5-year overall survival rates for all the patients were 58.8% （ 10/17 ）, 29.4% （5/ 17） and 11.7% （2/17）, respectively. In patients with liver resection, the survival rates were 83.3% （ 10/ 12）, 41.6% （5/12） and 16.7% （2/12）, and for R0 resection, 100.0% （10/10）, 50.0% （5/10） and 20.0% （2/10）, respectively. Conclusions The diagnosis of primary sarcoma of liver was difficult before operation. High survival rate could be achieved by radical resection and adjuvant chemotherapy.

关 键 词：原发性肝肉瘤 肝肿瘤 肝切除术 化疗 

分 类 号：R735.7[医药卫生—肿瘤]