原发性肝癌的外科治疗——附5524例报告

目的 探讨原发性肝癌的外科治疗效果。方法 1960年1月至1998年12月共施行原发性肝癌肝切除术5524例。比较1960年-1997年（181例）、1978年-1989年（921例）、1990年-1998年（4422例）3个阶段肝癌治疗的效果。结果 3个阶段术后1个月内住院病死率分别为8.48%、0.43%、0.31%，而5年生存率分别为16.0%、30.6%和48.6%。结果表明，以常温下间歇肝门阻断，指捏加钳夹法切肝，大血管损伤的妥善处理和局部根治性肝切除为标志的肝脏外科技术，在肝癌外科技术中具有普遍的实用价值。结论 早期肿瘤切除、术前有趣 动脉托管化疗栓塞、术中无瘤枝术、术后综合治疗、以及肿瘤复发再切除可显著延长患者无瘤生存期，降低肝癌复发的危害性。二期切除可使中晚期肝癌患者重获得手术切除机会。但并非适用于所有大肝癌，对肝癌的可切除性要有一个准确的判断。

Surgical treatment of primary liver cancer: report of 5 524 cases

Objective　To study the results of surgical treatment of patients with primary liver cancer.　Methods　From January 1960 to December 1998, 5?524 patients with pathologically proven primary liver cancer (PLC) underwent hepatectomy.Their results were compared in 3 periods: 1960-1977 (181 patients),1978-1989(921), and 1990-1998（4?422).　Results　Surgical outcomes were improved gradully as shown by the five-year survival rate of 16.0% for the period of 1960-1997, 30.6% for 1978-1989, and 48.6% for 1990-1998. The operative mortality rate was in a decreased order from 8.48%, 0.43% to 0.31% during the three periods. These data indicated the progress in clinical research of PLC and the importance of surgery. Normothemic intermittent interruption of the porta hepatis, transection with finger-fracture and forceps, radical local resection and management of huge tumor involving the porta hepatis and IVC were the main approaches in our practice.　Conclusions　Postoperative recurrence remains to be a problem. Tumor-free survival, however, could be increased by early detection and resection, preoperative TACE, no iatrogenic dissemination, postoperative comprehensive treatment, and reoperation. Two-stage operation is only indicated for unresectable PLC but not for large tumors involved the porta hepatis or IVC. The resectability should be judged carefully.