逆行肝切除术等在大肝癌综合治疗中的应用研究

目的：探讨大肝癌有效切除合理手术方式和合理治疗方法。方法：通过对80例大肝癌患者术前多项因素综合判定肝储备能力，将患者分为4组，Ⅰ组为可切除组，行逆行肝切除结合置泵栓塞化疗等综合治疗；Ⅱ组为可切除组，于项目之前完成的常规肝切除结合置泵栓塞化疗等综合治疗；Ⅲ组为不能切除组，采用开腹射频消融结合置泵栓塞化疗等综合治疗；Ⅳ组为不愿开腹手术，行介入栓塞化疗等综合治疗。每组20例患者。结果：Ⅰ组1年内生存15例，死亡5例，1年生存率75％；3年内生存8例，死亡12例，3年生存率40％。Ⅱ组1年内生存13例，死亡7例，1年生存率65％；3年内生存4例，死亡16例，3年生存率20％。Ⅲ组1年内生存8例，死亡12例，1年生存率40％；3年内无生存病例。Ⅳ组1年内生存仅2例，死亡18例，1年生存率10％；3年内无生存病例。结论：（1）逆行肝切除术等综合治疗大肝癌较常规手术明显降低术后并发症，提高生存率。（2）对于不能切除的大肝癌，射频消融结合置泵栓塞化疗等综合治疗大肝癌较其他综合治疗方法有较好的疗效。

Application of Retrograde Hepatectomy in Comprehensive Treatment of Large Hepatocellular Carcinoma

Objective： To study the effective removal of reasonable operation methods and a reasonable treatment of large hepatocellular carcinoma. Methods： Eighty cases with large hepatocellular carcinoma were studied, and the comprehensive judgment of multiple factors in preoperative liver reserve capacity was done. There were 4 gruoups. Ⅰgroup ： could do resection, line retrograde hepatectomy combined reset pump embolism chemotherapy, integrated treatment; Ⅱ Group： could do resection, before project completed of general hepatectomy combined reset pump embolism chemotherapy, integrated treatment; Ⅲ group： couldnot do resection, opened abdominal radio requency ablation combined reset pump embolism chemotherapy, integrated treatment; Ⅳ group： unwilling to open abdominal surgery, line intervention embolism chemotherapy, integrated treatment. 20 patients were in each group. Results： Group Ⅰ ： year survival were 15 cases, death 5 cases, 1 year survival rate was 75%. 3 years survival were 8 cases, death 12 cases, 3 years surviral survival was 40%. GroupⅡ ： 1 year survival were 13 cases, death 7 cases, 1 year survival rate was 65%. 3 years survival 4 cases, death 16 cases, 3 years surviral survival was 20%. Group Ⅲ ： 1 year survival were 8 cases, deaths 12 cases, 1 year survival rate was 40%. 3 years no cases of survival. Group Ⅳ： 1 year survival were only 2 cases, death 18, 1 year survival rate was 10%. 3 years no cases of survival. Conclusions： （1） Retrograde hepatectomy for comprehensive treatment of large hepatocellular carcinoma compared with conventional surgery significantly reduces postoperative complications, improves the survival rate. （2） For unresectable large hepatocellular carcinoma, radio-frequency ablation combined with pump insertion embolization chemotherapy in comprehensive treatment of large hepatocellular carcinoma compared with other methods of treatment have a better effect.