肝细胞癌合并乙肝肝硬化病人肝切除安全性评估专家共识  

Expert consensus on safety assessment of hepatectomy for hepatocellular carcinoma with HBV-related liver cirrhosis Chinese

作　　者：国际肝胆胰协会中国分会 中华医学会外科学分会肝脏外科学组 黄志勇[2] 张二雷 张尊义 梁宾勇 商昌珍 Chapter of the International Hepato-Pancreato-Biliary Association;Hepatic Surgery Group of Surgical Branch of Chinese Medical Association

机构地区：[1]不详 [2]华中科技大学同济医学院附属同济医院肝脏外科中心,武汉 [3]中山大学孙逸仙纪念医院

出　　处：《临床外科杂志》2025年第3期225-236,共12页Journal of Clinical Surgery

摘　　要：在我国,约80%以上的肝细胞癌(简称肝癌)病人合并有不同程度的乙肝后肝硬化。与西方国家不同,肝切除术仍是我国治疗肝癌合并肝硬化病人的重要手段之一。肝癌病人肝硬化的严重程度个体差异较大,虽然代偿期时肝功能可处于正常范围,肝硬化程度加重导致肝脏储备功能及再生能力显著下降,肝切除术后并发症及肝衰竭的发生率就越高。因此,需要对合并不同程度肝硬化的肝癌病人实施尽量多保留肝实质的肝切除,保证手术安全。由于目前对不同程度肝硬化影响肝癌肝切除术后发生肝功能衰竭的认识不足,尚无针对伴有不同程度肝硬化肝癌病人如何合理选择手术方式的共识,是影响肝癌病人肝切除手术安全的重要因素之一。如何降低伴有肝硬化的肝癌病人肝切除术后肝衰竭发生率及死亡率,值得深入研究。国际肝胆胰协会中国分会、中华医学会外科学分会肝脏外科学组邀请多位国内知名肝脏外科及肝病专家,深入探讨肝硬化程度在肝癌病人肝切除安全性评估中的作用及如何提高手术安全性,该共识旨在帮助肝脏外科医生对肝癌合并肝硬化病人制定合理的外科手术决策,提高手术安全性。In China,more than 80%of patients with hepatocellular carcinoma(HCC)are associated with varying degrees of HBV-related liver cirrhosis.Different from the Western countries,hepatectomy remains as the one of the mainstay choices for HCC with liver cirrhosis.The severity of cirrhosis of HCC patients varies greatly from individual to individual.Although the patients’liver function is at the compensated stage.With the development of liver cirrhosis,both hepatic functional reserve and regenerative capacity are considerably diminished,the incidence of surgical complications and post-hepatectomy liver failure will increase correspondingly.Therefore,maximally preserving the amount of liver parenchyma is crucial to maintaining essential liver function for cirrhotic HCC patients.The insufficient understanding of the relationship between post-hepatectomy liver failure and the severity of liver cirrhosis for patients has led to a lack of agreement on selecting reasonable surgical modalities and preserving sufficient future liver remnant volume.This results in a scarcity of concrete guidance for clinically preventing and treating post-hepatectomy liver failure,substantially compromising the surgical efficacy in HCC patients.Minimizing the incidence of postoperative hepatic insufficiency and mortality rates in cirrhotic HCC patients deserve to be further studied.The Chinese Chapter of the International Hepato-Pancreato-Biliary Association and Hepatic Surgery Group of Surgical Branch of Chinese Medical Association invited well-known experts in liver surgery and hepatology in China,mainly elaborate the role of the severity of liver cirrhosis in the safety evaluation of hepatectomy,and how to improve surgical safety,which may assist liver surgeons to make appropriate surgical decisions for HCC patients with liver cirrhosis.

关 键 词：肝细胞癌 专家共识 肝切除 乙肝 肝硬化 安全性评估 

分 类 号：R73[医药卫生—肿瘤]