原发性肝癌以外科为主的综合治疗(附425例报告)

目的：探讨肝癌以外科为主的综合治疗。方法：以外科为主综合治疗原发性肝癌患者425例，其中直径≤5cm的小肝癌121例。行不规则性肝叶切除134例，局部切除95例，肝叶或肝段切除123例，半肝或半肝以上切除共56例，联合脏器切除17例；切缘注射无水酒精或用渗入无水酒精的明胶海绵包埋于瘤床共39例。结果：总的手术切除率69.8%，小肝癌手术切除率90.3%；手术死亡率1.2%；术后生存5年以上118例，10年以上24例。全组术后3、5、10年生存率分别为57.2%(203/355)、51.3%(118/230)和35.3%(24/68)；其中小肝癌术后3、5、10年生存率分别为74.4%(64/86)、64.6%(42/65)和43.8%(14/32)。结论：以外科为主的综合治疗是目前治疗肝癌最有效的方法。不规则性肝切除、早期发现肝癌、综合治疗大肝癌缩小后二期切除等是提高手术切除率的主要手段；以个体化为原则的术后综合治疗可降低术后复发率，提高肝癌的治疗效果。

Surgical Comprehensive Therapy for Primary Liver Cancer - A Report of 425 Cases

Objective:To evaluate the effect of surgical comprehensive therapy for primary liver cancer(PLC).Methods:Four hundred and twenty-five patients with PLC received surgical comprehensive therapy in our hospital from1985to2001.One hundred and twenty-one patients had a tumor of5cm in diameter.The surgical modality for all the425cases were as follows:Irregular hepatectomy 134cases,radical resection95cases,regular liver lobe resection or seg-ment resection123cases,semi-hepatectomy 56cases and hepatectomy combined with other organ resection17cases.Results:The overall resectable rate was69.8%and that of small PLC90.3%with an operative mortality1.2%.The3-,5-,10-year survival rates were57.2%,51.3%,35.3%respectively.Conclusion:The results showed that surgical comprehensive therapy is the most effective way for PLC.The key procedure to improve the resectable rate of PLC is early diagnosis,irregular hepatectomy and two-stage resection for the large tumors.Postoperative indi-vidualized therapy is important for preventing tumor recurrence and improving long-term results.