老年胃癌患者的手术治疗

Objective To explore the clinical characteristics and surgical treatment of gastric cancer in elderly patients.Methods The clinical data of 431 patients older than 70 years with gastric cancer from 1984 to 1998 were analyzed retrospectively.Results The main clinical manifestations were upper abdominal pain,distension or upset,loss of appetite and weight.The patients with clinicalⅢ,Ⅳ stage accounted for 64.2 percent.Pathological findings showed no specificity.Radical gastrectomy was performed in 215 cases(49.9%),and palliative resection was done in 122 ones(28.3%).The operative mortality and postoperative complication rate were 5.1%and 25.5%in the patients respectively.The 5-year survival rate was 29.5%in the patients with surgery,53.2%with radical gastrectomy and 10.7%with palliative resection.There were significant differences in 5-year survival rate between the radical and palliative groups.Conclusions The majority of elderly patients are clinical Ⅲ,Ⅳ stages and their operative complication rate is high.The key to increase the survival rate and life quality of elderly patients with gastric cancer is early diagnoses,strong perioperative management and suitable radical surgery.     

老年胃癌患者的手术治疗

Objective To explore the clinical characteristics and surgical treatment of gastric cancer in elderly patients.Methods The clinical data of 431 patients older than 70 years with gastric cancer from 1984 to 1998 were analyzed retrospectively.Results The main clinical manifestations were upper abdominal pain,distension or upset,loss of appetite and weight.The patients with clinicalⅢ,Ⅳ stage accounted for 64.2 percent.Pathological findings showed no specificity.Radical gastrectomy was performed in 215 cases(49.9%),and palliative resection was done in 122 ones(28.3%).The operative mortality and postoperative complication rate were 5.1%and 25.5%in the patients respectively.The 5-year survival rate was 29.5%in the patients with surgery,53.2%with radical gastrectomy and 10.7%with palliative resection.There were significant differences in 5-year survival rate between the radical and palliative groups.Conclusions The majority of elderly patients are clinical Ⅲ,Ⅳ stages and their operative complication rate is high.The key to increase the survival rate and life quality of elderly patients with gastric cancer is early diagnoses,strong perioperative management and suitable radical surgery.     

腹腔镜结直肠癌根治术疗效分析

Objective To investigate the efficacy of laparoscopic radical resection for colorectal cancer. Methods From September 2000 to December 2004, 99 patients with colorectal cancer underwent laparoscopic radical resection (laparoscopic group) and 198 patients with colorectal cancer underwent open radical resection (open group) at the Union Hospital of Fujian Medical University. The differences in local recurrence and survival between the two groups were compared. The local recurrence of tumors and survival of patients in the two groups were calculated by the life-table method, and were compared by the Wilcoxon (Gehan) test, chi-square test and Fisher's exact test. The recurrence interval and survival time of the two groups were compared by non-parametric Wilcoxon rank sum test. Results The 2-and 3-year local recurrence rates in the laparoscopic group were both 3.0% and the overall local recurrence rate was 3.0% (3/99). The 2-and 3-year local recurrence rates in the open group were 2.6% and 4.0% , respectively, and the overall local recurrence rate was 3.5% (7/198), with no significant difference between the two groups (χ2 =0.002, P > 0. 05). The median survival time of patients with local recurrence was 15 months (range, 7-24 months) in the laparoscopic group and 11 months (range, 2-28 months) in the open group, with no significant difference between the groups (U = 15. 500, P >0. 05). The 1-year survival rate was 33.3% in the laparoscopic group and 42.9% in the open group. The 2-year survival rate was zero in the laparoscopic group and 42. 9% in the open group. There were no significant differences between the groups for the 1-and 2-year survival rates (χ2 =0.120, P>0.05). Conclusions The efficacy of laparoscopic radical resection for colorectal cancer is similar to that of open surgery. Laparoscopic radical resection for colorectal cancer is safe and feasible, and does not increase the recurrence rate of cancer.     

腹腔镜结直肠癌根治术疗效分析

Objective To investigate the efficacy of laparoscopic radical resection for colorectal cancer. Methods From September 2000 to December 2004, 99 patients with colorectal cancer underwent laparoscopic radical resection (laparoscopic group) and 198 patients with colorectal cancer underwent open radical resection (open group) at the Union Hospital of Fujian Medical University. The differences in local recurrence and survival between the two groups were compared. The local recurrence of tumors and survival of patients in the two groups were calculated by the life-table method, and were compared by the Wilcoxon (Gehan) test, chi-square test and Fisher's exact test. The recurrence interval and survival time of the two groups were compared by non-parametric Wilcoxon rank sum test. Results The 2-and 3-year local recurrence rates in the laparoscopic group were both 3.0% and the overall local recurrence rate was 3.0% (3/99). The 2-and 3-year local recurrence rates in the open group were 2.6% and 4.0% , respectively, and the overall local recurrence rate was 3.5% (7/198), with no significant difference between the two groups (χ2 =0.002, P > 0. 05). The median survival time of patients with local recurrence was 15 months (range, 7-24 months) in the laparoscopic group and 11 months (range, 2-28 months) in the open group, with no significant difference between the groups (U = 15. 500, P >0. 05). The 1-year survival rate was 33.3% in the laparoscopic group and 42.9% in the open group. The 2-year survival rate was zero in the laparoscopic group and 42. 9% in the open group. There were no significant differences between the groups for the 1-and 2-year survival rates (χ2 =0.120, P>0.05). Conclusions The efficacy of laparoscopic radical resection for colorectal cancer is similar to that of open surgery. Laparoscopic radical resection for colorectal cancer is safe and feasible, and does not increase the recurrence rate of cancer.     

胆囊癌不同手术方式的疗效分析

Objective To investigate the therapeutic effects of different surgical procedures for the treatment of gallbladder cancer. Methods The clinical data of 81 patients with gallbladder cancer who were admitted to the West China Hospital of Sichuan University from January 2000 to October 2009 were retrospectively analyzed.The efficacies of different surgical procedures for the treatment of gallbladder cancer, and the relationship between T stage and lymph node metastasis were investigated. The postoperative survival rates of patients in different TNM stages were analyzed and compared using the Kaplan-Meier method and Log-rank test, respectively. Results The median survival times of patients in stage Ⅰ , Ⅱ ,Ⅲ and Ⅳ were 68, 18, 7 and 5 months, respectively. The 1-,3-, 5-year survival rates were 100%, 80% and 60% for patients in stage Ⅰ, 57%, 29% and 14% for patients in stage Ⅱ, 27%, 7% and 0 for patients in stage Ⅲ and 11%, 4% and 0 for patients in stage Ⅳ. There were significant differences in the survivals of patients in different TNM stages ( P ＜ 0.05 ). Of the 81 patients, 67 received surgical treatment. The 5-year survival rate was 100% for patients in stage T1b who received standard radical resection and 0 for patients who received simple cholecystectomy. The median survival time was 45 months for patients in stage Ⅱ who received standard radical resection and 12 months for patients in stage Ⅱ who received simple cholecystectomy, and their 1-, 3-, 5-year survival rates were 67%, 33%, 33% and 50%, 0, 0, respectively, with significant differences ( P ＜ 0. 05 ). The 1-, 3-, 5-year survival rates of patients in stage Ⅲ who received standard radical resection were 33%, 17% and 6%, respectively. The survival time of patients who received extended radical resection was longer than 12 months, while the survival time of patients who received standard radical resection or other palliative therapy was shorter than 12 months. The 1-, 3-, 5-year survival rates of patients in stage Ⅳ who received extended radical resection and standard radical resection were 38%, 12%, 0and 14%, 0, 0, respectively. The survival time of patients in stage Ⅳ who received other treatments was shorter than 12 months. Lymph node metastasis were identified in 7 patients in stage T2(n = 15), 7 patients in stage T3(n = 14), and 12 patients in stage T4(n = 13), no patient in stage T1 (n =2) was found with lymph node metastasis. Conclusions Lymph node metastasis is significantly influenced by the depth of invasion of the gallbladder cancer. For patients in stage T1b, Ⅱ and Ⅲ, radical resection of gallbladder cancer is necessary; for patients in stage Ⅳ, although the incidence of complication is higher, the survival time is much longer when compared with other treatments.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

手术切除治疗肝门部胆管癌

目的 总结肝门部胆管癌手术治疗的经验.方法 回顾性分析本院9年因肝门部胆管癌行手术切除的83例病人的临床资料和随访结果.结果 83例手术切除病人中行根治性切除（R0）31例,非根治切除52例（R1,R2）,术后出现并发症29例,死亡5例.根治性切除组中位生存期21.5个月,1、3、5年生存率分别为79.6%,43.3%和25.9%,明显优于非根治性切除组（P＜0.05），近5年本院根治性切除率达44.8%,中位生存期18.7个月,疗效明显提高（P＜0.05），结论 加强围手术期处理、术中行切缘冰冻病理检查、联合肝切除等可提高肝门部胆管癌根治性切除率、减少并发症和死亡率;根治性切除可更好延长病人生存期,使手术治疗肝门部胆管癌获得良好的疗效.     

Surgical treatment of alveolar echinococcosis of the liver

Cure of alveolar echinococcosis of the liver can be achieved by complete removal of the lesion, this being possible only by hepatic resection. Nevertheless, 25% of patients have unresectable lesions. The purpose of this work was to analyze the clinical sequelae and prognosis of patients after curative and palliative surgery for alveolar echinococcosis of the liver. The 10-year survival rate of patients who underwent hepatectomy with complete resection of the lesion was 100% compared with 63% in the patients who had hepatectomy with incomplete resection of the lesion. Thirty-seven patients with unresectable hepatic echinococcosis were divided into two groups; the 10 patients in group A underwent only exploratory laparotomy, and the 27 patients in group B had palliative surgery. In group B, marsupialization or cyst drainage was performed in 17 patients, biliary drainage in 6 patients, and biliary reconstruction in 4 patients. The outcome after surgery was compared in the two groups. The 5-year survival of the patients in group A was 30%, and all patients died of liver failure within 7 years. The survival rates of patients in group B were 60% at 5 years, 55% at 10 years, and 35% at 15 years. Complete removal of the lesion by hepatectomy results in satisfactory prognosis. Palliative surgery may offer improvement in terms of survival and quality of life when complete removal is not possible.     

103例肝门部胆管癌的外科手术切除治疗

目的总结103例肝门部胆管癌采用手术切除治疗的经验。方法回顾性分析10年来行手术切除的肝门部胆管癌103例患者的临床资料和随访结果。结果本组行根治性（‰）切除43例,根治性切除率为41．7％,非根治性（R,,R2）切除60例（58．3％）,术后发生并发症34例,手术死亡8例。根治性切除组中位生存期29．9个月,1、3、5年生存率分别为69．6％、42．0％、20．9％,明显优于非根治性切除组34．1％、10．2％、0（P＜0．05）。本组近5年术前减黄治疗42例,合并肝切除达53．8％,根治性切除率达45．7％,中位生存期24．7个月,疗效明显提高（P＜0．05）。结论肝门部胆管癌作根治性手术切除能更好延长患者生存期,使手术治疗获得良好的疗效。随着近年来加强围手术期处理、术中行切缘冰冻病理检查、联合肝切除等提高了肝门部胆管癌根治性切除率。     

扩大根治术在肝外器官侵犯的胆囊癌中的作用

目的 探讨扩大根治术在肝外器官侵犯的胆囊癌患者中的作用.方法 总结2009年12月至2013年12月我院21例行手术治疗的胆囊癌合并肝外器官侵犯患者,16例行联合侵犯脏器切除的胆囊癌扩大根治术,包括4例联合胰十二指肠切除术,3例联合部分横结肠切除术,5例联合胆总管肝总管切除术、肝总管空肠内引流,1例联合右肝动脉切除术,1例联合门静脉左支切除重建术,2例联合远端胃切除术;5例仅行剖腹探查、姑息性胆囊切除或T管外引流.结果 全组无手术死亡,并发症发生率28.6％ （6/21）,扩大根治术组1、2、3年生存率分别为62.5％、37.5％、12.5％,中位生存期21.5个月,均优于姑息性手术组.16例扩大根治术后病理,15例淋巴结阳性,其中腹主动脉旁淋巴结阳性2例.结论 对于肝外器官侵犯的胆囊癌患者,施行联合侵犯器官切除的扩大根治术,能提高手术切除率和生存率,只要仔细选择病例,扩大根治术可以安全施行.     

肝泡型包虫病根治性切除163例回顾性分析

目的:探讨肝泡型包虫病根治性切除的治疗效果。方法:回顾性分析2013年1月—至2015年6月163例行根治性切除肝泡型包虫病患者的临床资料。结果:根治性手术平均时间(3.1±1.2)h,术中出血量(763±498)m L。术后携带腹腔引流管中位时间6 d,11例携带T管,术后1个月拔除。术后平均肛门排气时间(2.1±0.8)d、经口进食时间(2.7±1.1)d、住院时间(7.9±3.4)d。8例出现术后并发症,其中5例术后胆瘘,1例术区感染,2例术后腹水。术后电话或门诊随访1~6个月无死亡及包虫复发情况。结论:根治性切除是当前肝泡型包虫病患者的首选治疗方案。术前充分评估手术可行性,术中充分掌握肝脏血流控制、肝脏外科解剖、门静脉重建、胆管重建等技术,通过根治性手术切除可明显改善泡型包虫病患者的生存质量,延长患者的生存时间。     

联合肝叶及血管切除重建根治术治疗肝动脉受侵肝门部胆管癌的近期随访

目的探讨联合肝叶及血管切除重建根治术治疗肝动脉受侵肝门部胆管癌(HCCA)的临床效果和预后情况。方法回顾性分析2016年10月至2019年10月肝动脉受侵HCCA患者98例资料,根据手术方式不同将患者分为联合组(HCCA根治术+肝叶切除+肝动脉切除重建术)51例和姑息组(姑息性胆管肿瘤切除术/内引流减黄手术)47例。所有数据均采用SPSS22.0软件处理分析,两组患者术中术后各项指标以(±s)表示,采用独立样本t检验。并发症比较采用χ^2检验;采用Kaplan-meier绘制患者的生存曲线;以P<0.05为差异有统计学意义。结果联合组手术时间、住院费用明显高于姑息组,但术中出血量、住院时间明显低于姑息组(P<0.05)。联合组并发症发生率为52.9%,与姑息组的42.6%比较,差异无统计学意义(P>0.05);两组均未发生围术期死亡。随访时间截至2019年11月,联合组的1年、2年、3年生存率分别为84.3%、66.7%、43.1%,,明显高于姑息组的17.0%、10.6%、4.3%(P<0.05)。结论联合肝叶及血管切除重建根治术用于治疗肝动脉受侵HCCA,可有效减少术中出血量,提高患者的生存率。     

肝癌破裂出血的治疗：附35例临床分析

目的探讨肝癌破裂出血的治疗方法及疗效。方法回顾分析近9年余收治的35例肝癌破裂出血患者临床资料。其中，行根治性手术12例（包括介入术后行根治性手术5例），姑息性手术9例，介入治疗19例（其中5例术后改行根治性手术）。结果根治性手术组术后彻底止血，1例术后死于肝功能衰竭；姑息性手术组术后再出血3例，其中2例死于肝功能衰竭；介入治疗组再出血1例，发生肝功能衰竭2例，死亡1例。根治性手术12例中生存1年者9例，2年者7例，5年者4例；姑息性手术9例中，生存1年者2例，2年者1例；介入治疗组14例中生存1年者8例，2年者4例，5年者1例。结论根治性手术切除是治疗肝癌破裂出血的有效方法。介入治疗止血满意，并发症少，能有效地延长患者生存期，可作为不能行切除手术患者的首选治疗方法；行介入治疗止血时可通过血管造影判断有无行根治性手术的可能，以减少不必要的急诊手术探查。     

肝门部胆管癌手术疗效的临床研究

目的 探讨肝门部胆管癌不同手术方式的临床疗效.方法 对89例肝门部胆管癌病人的临床资料进行回顾性研究.按治疗方式分为3组:根治性切除组(n=23),姑息性切除组(n=44),外引流手术组(n=22).对3组病人术后并发症、生存率、生存质量进行比较.结果 根治组术后并发症高于引流组(P<0.05),其与姑息组比较无显著性差异(P>0.05),两组围手术期死亡率比较无显著性差异(P>0.05),1、2、3年生存率比较根治组显著高于其它两组(P<0.01),生存质量比较根治组显著性高于姑息组及引流组(P<0.01),姑息组生存质量又显著性高于引流组(P<0.01).结论 肝门部胆管癌根治性切除能提高远期生存率,同时能明显提高病人的生存质量,对不能根治切除的病人,应争取行姑息性切除,亦可延长生存时间,改善生存质量.     

Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis

BACKGROUND: Alveolar echinococcosis is a rare disorder, which makes a comparison of different treatment modalities within a clinical trial difficult to perform. Data prospectively recorded over a period of 25 years were used to evaluate three therapeutic strategies: benzimidazole therapy alone, complete 'curative' resection followed by 2 years of adjuvant benzimidazole treatment, and partial debulking resection followed by continuous administration of a benzimidazole. METHODS: Details of 113 patients with hepatic alveolar echinococcosis treated between 1976 and 2003 were analysed. Kaplan-Meier survival curves were constructed and, using a Cox regression model, patient age, year of initial treatment and PNM stage were entered as co-variates in the analysis. RESULTS: Kaplan-Meier overall survival curves stratified for treatment strategy indicated an improved long-term survival in patients undergoing the debulking procedure (P = 0.061) or curative resection (P = 0.002) compared with benzimidazole therapy alone. However, when PNM stage, patient age and year of initial treatment were introduced into the analysis, there was a trend for survival advantage only with curative resection (P = 0.07 versus benzimidazole alone). Debulking resulted in a higher rate of progression of hepatic echinococcosis than curative surgery (P = 0.008). The incidence of parasite-related complications was similar for debulking resection and benzimidazole therapy alone (P = 0.706). CONCLUSION: Debulking hepatic resections do not appear to offer any advantage in the treatment of patients with alveolar echinococcosis.     

姑息性肝切除加综合治疗在肝癌治疗中的地位

目的 探讨姑息性肝切除加上积极的综合治疗对晚期肝癌的疗效。方法 对3例作过肝切除的晚期肝癌病例进行了回顾性分析;这些病例术中有明确的癌灶遗留,术后经积极的综合治疗得以长期存活。在这些病例经验的基础上,自1997年1月～2001年5月进一步对19例晚期肝癌作了姑息性切除和积极的综合治疗并对其近期疗效进行观察。结果 本组无手术死亡;19例中12例已死亡,存活2～8个月,该12例的中位生存期为5个月;11/19例存活7个月以上;7例至今仍然生存已7～48个月,其中1例术后遗留巨大癌栓经综合治疗后消失,存活已3年;全组中位生存期为11.8个月。结论 对既不能作根治性切除,又不适宜作肝动脉栓塞化疗或肝动脉栓塞化疗效果不良的晚期肝癌,如果切除主病灶不会导致病人死亡或发生严重的并发症,不应放弃手术,作主病灶切除后加上积极的综合治疗,作为姑息性的减体积手术对部分病人仍有裨益。