Evaluation of partial hepatectomy for primary liver carcinoma

From 1964 to 1985, 120 cases of primary liver carcinoma had undergone hepatectomy in our hospital. Seven of these cases underwent hepatic lobectomy, 28 cases had palliative hepatic resection, and 85 cases had partial hepatectomy. We introduced different surgical modes and compared the mortality, survival rates, and complications between the hepatic lobectomy and partial hepatectomy groups. The mortality rates of these two groups were 14.3 and 3.5%, respectively, and the 1, 3, and 5 year survival rates were 83.3, 33.3, and 16.7 and 68.8, 48.1, and 20%, respectively. In the palliative hepatectomy group (28 cases), ten cases received combined radiotherapy postoperation. Most of these cases died during the first year postoperation. Primary liver cancer in Asia is commonly associated with hepatic cirrhosis. We suggest that partial hepatectomy is suitable for such patients. The results of the present series showed that the outcomes of the hepatic lobectomy and partial hepatectomy groups did not differ, but in partial hepatectomy, the operative mortality and complications were reduced, bleeding minimized, and operation time also shortened.     

RESULTS OF HEPATECTOMY FOR HUGE PRIMARY LIVER CANCER

ＲＥＳＵＬＴＳＯＦＨＥＰＡＴＥＣＴＯＭＹＦＯＲＨＵＧＥＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＬｉＧｕｏｈｕｉ；李国辉；ＬｉＪｉｎｑｉｎｇ；李锦清；ＺｈａｎｇＹａｑｉ；张亚奇；ＣｕｉＳｈｕｚｈｏｎｇ；崔书钟；ＹｕａｎＹｕｎｆｅｉ；元云飞（ＴｕｍｏｒＨｏｓ...     

原发性肝癌的综合治疗--附607例报告

背景与目的：虽然原发性肝癌(简称肝癌)的早期诊断和早期治疗取得了很大进步,但大多数为合并有肝硬化的中晚期肝癌患者,手术切除并非适合所有肝癌患者,即使能切除,术后复发率也高达60％以上,因而,肝癌的整体治疗效果较差。本研究探讨肝癌的综合治疗方法,以进一步提高肝癌的整体治疗效果。方法：回顾性分析我科以外科为主综合治疗的607例肝癌患者的病例资料,其中,手术切除共423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54例,联合脏器切除17例;手术不能切除184例,行肝固有动脉结扎联合肝动脉及门静脉双插管化疗或瘤体内注射无水乙醇或冷冻、射频治疗、微波固化、腹腔化疗等。结果：总的手术切除率69．7％(423／607),手术死亡率1．2％(5／423);全组3、5、10年生存率分别为42．7％(218／511)、37．5％(123／328)和26．5％(26／98);切除组3、5、10年生存率分别为57．2％(203／355)、51．3％(118／230)和35．3％(24／68);不能切除组3、5、10年生存率分别为9．6％(15／156)、5．1％(5／98)和6．7％(2／30)。结论：以外科为主的综合治疗是目前可切除肝癌较好的治疗方法。术后个体化综合治疗可提高肝癌的手术治疗效果。     

腹腔镜肝癌根治术治疗肝癌的临床疗效及对NGF、MMP-13水平的影响

目的:研究腹腔镜肝癌根治术治疗肝癌的临床疗效及对神经生长因子（nerve growth factor,NGF）、基质金属蛋白酶-13（matrix metalloproteinase-13,MMP-13）水平的影响。方法:选取2012年1月至2016年12月我院收治的原发性肝癌患者65例，分别采用开腹肝癌切除术（对照组）和腹腔镜肝癌根治术（观察组），分析两组患者治疗后的临床效果。结果:观察组患者手术时间、排气时间、拔管时间、绝对卧床时间、住院时间均短于对照组；术后3 d时，观察组患者MMP-13、ICAM-1、NGF、PⅢP、PCT水平低于对照组；术后1个月，观察组患者肝功能指标水平低于对照组，差异有统计学意义（P＜0.05)。随访1年后，观察组患者复发率和转移率分别为15.15%、3.03%；对照组分别为28.13%、12.50%；观察组患者复发率和转移率低于对照组，但组间比较无统计学差异（P＞0.05)。结论:腹腔镜肝癌根治术较开腹肝癌切除术治疗肝癌更有利于促进肝功能的恢复，可降低MMP-13及NGF水平，且恢复快，住院时间短，但复发率和转移率比较，无明显差异。     

Significance of radical recurrent tumor resection for recurrent gastric cancer as assessed by prognosis]

To evaluate the relationship between radical surgery of recurrent tumor and prognosis in cases of recurrent gastric cancer, we analyzed data on 202 patients with relapsed gastric cancer, focusing on surgical recurrent tumor removal. In our series, 18 of the 202 patients underwent radical recurrent tumor resection. Resected tumors were located in the ovarium (n = 4), colorectum (n = 3), liver (n = 3), lymph node (n = 2), locoregional stoma (n = 2), and peritoneum, adrenal gland, brain, and lung (n = 1 each). No surgery-related mortality occurred. One patient remains alive over 5 years after hepatectomy without recurrence, and 17 died within 3 years: 7 patients from primary recurrence and 10 from multiple modes of recurrence. Median survival after recurrence (MSTAR) in the 18 radical surgery patients was 14 months, against 5 months in those treated palliatively (p = 0.0001). MSTAR for the ovary and the liver were 30 months and 15 months in the radical surgery cases, and 2.5 months for the ovary and 5 months for the liver in the palliative cases. Significant differences were thus seen between radical and palliative cases in the ovary (p = 0.010) and in the liver (p = 0.036). Median survival after gastrectomy was 45 months in the radical surgery cases, and 28 months in the palliative cases (p = 0.024). In postoperative gastric cancer follow-up, early detection of recurrence and radical surgery may well benefit patients with relapse, especially in the liver and ovary, in terms of survival.     

腹腔镜规则性肝叶切除术对原发性肝癌患者术后血清AFP、Hcy水平及生存质量的影响

目的:探讨腹腔镜规则性肝叶切除术对原发性肝癌患者术后血清甲胎蛋白（alpha fetoprotein,AFP）、同型半胱氨酸（homocysteine,Hcy）水平及生存质量的影响。方法:回顾性分析2009年10月至2012年10月四川省人民医院接受手术治疗的78例原发性肝癌患者临床资料,将采取腹腔镜规则性肝叶切除术的39例患者作为观察组,将采取开腹手术的39例患者作为对照组。观察两组手术情况、并发症发生情况与术后1年、3年、5年生存情况,比较两组术前、术后1周、术后1个月血清AFP、Hcy水平及术前、术后1年生存质量评分（SF-36）。结果:观察组术中出血量为（192.1±37.5） ml,低于对照组的（368.2±48.7） ml,观察组住院时间、腹腔引流时间、进食时间分别为（6.8±2.1） d、（2.7±1.3） d、（1.5±0.5） d,短于对照组的（11.5±2.7） d、（4.8±1.2） d、（3.0±0.8） d,差异有统计学意义（P<0.05）;术后1周、术后1个月观察组的血清AFP、Hcy水平低于对照组,差异有统计学意义（P<0.05）;观察组术后并发症发生率（7.7%）与对照组（17.9%）相比,差异无统计学意义（P>0.05）;术后1年观察组SF-36分值为（65.3±7.0）分,高于对照组的（58.5±6.4）分,差异有统计学意义（P<0.05）;术后1年观察组生存率（86.5%）高于对照组（65.7%）,差异有统计学意义（P<0.05）。结论:原发性肝癌患者予以腹腔镜规则性肝叶切除术治疗可明显降低患者术后血清AFP、Hcy水平,减轻手术创伤,促进其术后恢复,延长其生存时间,提高其生存质量。     

原发性肝癌合并胆管癌栓的外科治疗

目的：提高对原发性肝癌合并胆管癌栓的认识，探讨其诊断、治疗方法及疗效。方法：回顾性分析我院1998年1月至2004年1月间收治的42例原发性肝癌合并胆管癌栓的临床资料，施行根治性手术26例，其中18例肝叶切除＋胆总管切开取栓、T管引流术；8例肿瘤局部切除＋胆总管切开取栓、T管引流术；姑息性手术16例，其中6例胆总管切开取栓、T管引流术，10例胆总管切开取栓、T管引流术＋患侧肝动脉结扎术（其中4例＋门静脉DDS泵置入术）。均获得病理诊断，肝细胞癌32例（76．2％）。结果：根治性手术及姑息性手术1年、3年、5年生存率分别为65．4％（17／26），42．3％（11／26），15．4％（4／26）及18．8％（3／16）、6．3％（1／16），0（0／16）；总的1年、3年、5年生存率分别为47．6％（20／42），28．6％（12／42），9．5％（4／42）。结论：外科治疗明显改善患者生活质量，提高了生存时间，而根治性手术是原发性肝癌合并胆管癌栓的积极有效方法。     

"Three-Grade Criteria" of Radical Resection for Primary Liver Cancer

OBJECTIVE The present study was designed to develop the "ThreeGrade Criteria" for radical resection of primary liver cancer (PLC) and to evaluate its clinical significance.METHODS Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade I: complete removal of all gross tumors with no residual tumor at the excision margin. Grade Ⅱ: on or the primary branches of the portal vein, the common hepatic duct or its dition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level (with positive AFP before surgery)within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the "Three-Grade Criteria" these patients were divided into 6 groups: Grade Ⅰ radical group,Grade Ⅰ palliative group, Grade Ⅱ radical group, Grade Ⅱ palliative group,Grade Ⅲ radical group, Grade Ⅲ palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups.RESULTS The survival rate of patients receiving radical treatment was better than those receiving palliative treatment (P＜0.01). Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade Ⅰ, Ⅱ and Ⅲ who underwent radical resection was 43.2%,51.2% and 64.4%, respectively (P＜0.01).CONCLUSION The "Three-Grade Criteria" may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used,the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.     

肝内胆管囊腺癌临床诊治分析(附11例报告)

背景与目的:肝内胆管囊腺癌(intrahepatic biliary cystadenocarcinoma)是一种罕见的肝脏恶性肿瘤,临床资料较少,诊断和治疗缺乏经验.本研究探讨肝内胆管囊腺癌的临床病理特点及诊治方法.方法:回顾性分析四川大学华西医院1999年3月至2006年10月以来经手术和病理证实的11例肝内胆管囊腺癌的病历资料,通过研究其临床表现、病理特点、治疗方法和随访资料,结合文献分析肝内胆管理囊腺癌的临床诊治特点.结果:肝内胆管囊腺癌患者多以上腹部疼痛、腹胀不适为首发症状.术后病理示肝内胆管粘液性乳头状囊腺癌,其中有4例同时作了免疫组化,提示细胞角蛋白CK7( ).11例患者中,4例可见局部癌肿向肝组织浸润性生长,其中3例行姑息性切除,1例根治性切除,术后生存时间为12～23个月;7例癌组织局限于囊壁内,均行根治性切除,术后3例生存超过3年,其余4例中有1例于术后10个月肿瘤复发再手术,术后已随访14个月,仍生存.1例术后12个月肿瘤复发伴有肝内多发转移灶而行非手术治疗.1例于术后15个月出现腹水,未治疗死亡.其余1例失访.结论:肝内胆管囊腺癌多见于中老年女性,其恶性程度较实体癌低.癌肿向肝组织浸润性生长者预后较差,而局限于囊肿内者预后相对较好.     

微波肝切除治疗肝癌的远期疗效

目的研究微波肝切除治疗肝癌的远期疗效。方法５４例原发性肝癌因严重肝硬化或肝脏萎缩行微波肝切除,以３０８例原发性肝癌手术根治性切除作对照。结果微波组术后一、三、五年生存率分别为９０５％、６８８％、５４７％;有１４例（２５９％）复发,术后一、三、五年复发率分别为４８％、２８０％、４８１％。微波组合并严重肝硬化、肿瘤包膜不完整者多（Ｐ＜００１）,但与根治性切除组的远期疗效无显著性差异（Ｐ＞００５）。结论微波肝切除使部分合并严重肝硬化的肝癌患者获得肿瘤切除机会,并可能取得与根治性切除同样好的远期疗效     

“Three-Grade Criteria” of Radical Resection for Primary Liver Cancer

OBJECTIVE The present study was designed to develop the “Three- Grade Criteria” for radical resection of primary liver cancer （PLC） and to evaluate its clinical significance. METHODS Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade Ⅰ： complete removal of all gross tumors with no residual tumor at the excision margin. Grade Ⅱ： on the basis of Grade Ⅰ, additional 4 requirements were added： （1） the tumor was not more than two in number; （2） no tumor thrombi in the main trunks or the primary branches of the portal vein, the common hepatic duct or its primary branches, the hepatic veins or the inferior vena cava; （3）no hilar lymph nodes metastases; （4）no extrahepatic metastases. Grade Ⅲ ： in addition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level （with positive AFP before surgery） within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the “Three-Grade Criteria” these patients were divided into 6 groups： Grade Ⅰ radical group, Grade Ⅰ palliative group, Grade Ⅱ radical group, Grade Ⅱ palliative group, Grade Ⅲ radical group, Grade Ⅲ palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups. RESULTS The survival rate of patients receiving radical treatment was better than those receiving palliative treatment （P〈0.01）. Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade Ⅰ, Ⅱ and Ⅲ who underwent radical resection was 43.2%, 51.2% and 64.4%, respectively （P〈0.01）. CONCLUSION The “Three-Grade Criteria” may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used, the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.     

小肝癌切缘复发预防及临床处理方法的探讨

背景与目的随着医疗诊断技术的提高,越来越多的小肝癌被发现,目前治疗小肝癌首选的方法仍是手术切除,但其术后复发率高达60%以上。本研究中我们对临床小肝癌进行回顾对照分析,拟探讨降低小肝癌手术切缘复发率的方法。方法回顾性分析广东省开平市中心医院和中山大学肿瘤医院在1991年1月～2003年5月间收治的283例小肝癌患者的临床病理资料。由于85%以上的肝癌患者合并不同程度肝硬化和肝储备功能不良,故以非规则性肝切除术为主。其中作肿瘤剔出术加残端切缘注射无水乙醇或无水乙醇明胶海绵创面填塞术140例(研究组);143例仅作普通常规处理(对照组)。比较两组患者的年龄、性别、肿瘤部位、肿瘤分期、Child-Pugh分期无统计学意义。结果研究组和对照组切缘1年复发率分别为21.4%和4.4%,有显著性差异(P<0.05);肝内转移/再发率分别为26.1%和24.5%,无统计学意义(P>0.05)。研究组和对照组5年总生存率分别为57.3%、52.8%(P=0.48),5年无瘤生存率分别为35.2%、36.9%(P=0.51)。两组患者术后一周内体温均在39℃以下;均无明显白细胞升高、胆漏及出血出现。结论不规则肝切除术后残端用无水乙醇明胶海绵填塞,或在残端处注射无水乙醇,对减少术后残端局部复发有一定效果,但对术后转移复发再发无作用,此法简单经济实用,便于推广应用,副作用少。     

肝切除治疗原发性肝癌自发性破裂

目的 探讨肝切除治疗原发性肝癌自发性破裂(简称肝癌破裂)的作用。方法 分析我院1973年以来采用肝切除术治疗肝癌破裂12例的临床资料。结果 本组男10例，女2例。平均年龄42(22—65)岁。11例为急症肝切除术，1例为2期肝切除，包括肝左外叶切除6例，左内叶切除1例，左半肝切除1例，右肝部分切除2例，肿瘤局部切除2例。本组中Child-Paugh肝功能分级A组的11例中无死亡；B组者1例术后死于肝衰，手术死亡率为8．3％。术后生存的1例均获随访，平均生存时间为16．5个月，1，3，5年生存率分别为72．7，18．2％，9．1％。其中1例已无瘤生存25年9个月。结论 肝切除是治疗肝癌破裂的最好方法，当有可能时应争取施行。肝切除治疗肝癌破裂可能使患者获行长时间生存。     

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。     

复发转移性结直肠癌的外科治疗及预后分析

背景与目的:结直肠癌是常见恶性肿瘤之一,其发病率有逐渐增高的趋势.其主要的治疗方法是根治性手术,手术后的复发及转移是导致患者死亡的主要原因.目前复发性结直肠癌的再手术是提高患者生存率和生存质量的主要方法.本文探讨结直肠癌术后复发的原因、诊断和外科治疗方法.方法:回顾性分析2003-2006年35例复发与转移性结直肠癌的外科治疗及预后.结果:手术后1年内复发者9例 (26%),3年内复发者26例(74 %).本组35例复发或转移性结直肠癌均行再次手术,7例复发性直肠癌再切除4例,造瘘3例,28例复发性结肠癌中,根治性切除8例(包括5例肝转移灶切除),姑息性切除10例,盲肠或横结肠造瘘10例.总切除率为63 %(22/35),其中根治性切除率为55%(12/22),姑息性切除45%(10/22).术后随访6～36个月,2例失访,12例根治性切除组中,9例无瘤生存,1例肺转移,2例肝转移;23例姑息治疗组中,5例死亡,4例肝转移,其余14例带瘤生存.结论:结肠癌的手术治疗,应根据其生物学特点,采取规范的手术方式、彻底清除原发灶、转移的肠系膜及淋巴结,术中注意无瘤操作,术后酌情辅以化疗或放疗,定期随访,是预防结直肠癌术后复发的主要措施.而对复发和转移病例,应根据其部位、临床特征,选择以手术为主的综合治疗方案,酌情达到根治或姑息治疗的目的.     

肝癌切除术后栓塞化疗与LAK细胞／IL－2的作用

目的探讨肝癌切除术后进行栓塞化疗或（和）淋巴因子激活的杀伤细胞（ＬＡＫ）／白介素－２（ＩＬ－２）的远期疗效。方法回顾性分析肝癌切除术后３年以上患者１０４例，比较单纯切除（Ａ组）、切除加栓塞化疗（Ｂ组）和切除加栓塞化疗加ＬＡＫ细胞／ＩＬ－２（Ｃ组）的预后情况。结果３年生存率在Ａ、Ｂ、Ｃ组分别为３０％、５４．３％、５７．１％。根治性切除病例，Ａ、Ｂ、Ｃ组的３年复发率分别为７６．７％、４６．７％、４１．７％。单纯手术组的生存率显著低于其他两组，而根治性切除后的复发率则显著比另两组为高。结论肝癌切除联合栓塞化疗或（和）ＬＡＫ细胞／ＩＬ－２治疗有助于改善肝癌患者的预后。     

以外科手术为主综合治疗小肝癌134例临床报告

背景与目的：手术切除是治疗小肝癌的首选方法,但术后5年复发率高达35．4％－45．3％,是影响手术疗效的关键因素。本研究拟探讨以外科为主的综合治疗来降低小肝癌术后复发率。方法：以外科为主综合治疗小肝癌（直径≤5cm）患者134例,男119例,女15例,年龄18－70岁,中位年龄45岁;手术切除（切除组）121例,其中,不规则性肝叶切除16例,局部切除83例,肝叶或肝段切除12例,左半肝切除2例,联合胆吓切除8例;切除后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22例。手术不能切除13例,行肝固有动脉结扎合并肝动脉及门静脉双插管化疗或瘤体内注射无水酒精或冷冻、射频治疗、微波固化、栓塞化疗等。结果：小肝癌手术切除率90．3％,无手术死亡。切除组术后1、3、5、10年生存率分别为89．3％、74．4％、64．6％和43．8％;术后1、3、5年复发率分别为11．9％、23．8％和32．1％。全组1、3、5、10年生存率分别为88．8％、72．2％、63．4％和41．7％;1、3、5年复发率分别为15．9％、29．1％和36．6％。结论：手术切除是治疗小肝癌的有效方法,以个体化为原则外科为主的综合治疗可降低术后复发率,提高小肝癌治疗效果。     

Periampullary carcinoma

Fifty-five patients with periampullary caicinoma have been treated during a period of 32 years. This tumor represents only 0.01% of our solid tumor cases. Contrary to widely accepted opinion, periampullary carcinoma is not painless in many patients, and a palpable gallbladder is present in only 20% of patients. Twenty-four patients had a palliative operation with a 13% immediate mortality; the mean survival of this group was 13 months. Out of 26 patients who had a radical curative operation, 18 survived the procedure; the mean survival for this group was 31 months. We believe that nearly every patient harboring a periampullary carcinoma should be considered a candidate for pancreaticoduodenectomy unless the disease is so far advanced that survival is unlikely.     

多模式系列疗法治疗老年原发性肝癌153例分析

目的 探讨多模式系列疗法治疗老年原发性肝癌患者的可行性和临床疗效。方法 接受多模式系列治疗的老年(≥60岁)原发性肝癌患者153例,其中行肝切除术37例,深度冷冻治疗32例,非手术治疗84例(介入治疗为主8l例,局部治疗配合介入治疗为主3例)。行肝切除和冷冻治疗者,术后配合多疗程介入治疗,全部患者均配合生物免疫治疗和中药治疗。结果 肝切除术患者l,3,5年生存率分别为78.4％、46．4％和35．7％,无手术死亡。冷冻治疗者l,3,5年生存率分别为64.5％、40．9％和25.0％,手术死亡率为3.l％。非手术治疗患者中,8l例介入治疗者的l,3,5年生存率分别为47．5％、23．5％和4．3％,手术死亡率为1．2％;3例局部治疗配合介入治疗者已分别生存2．5,3．8和7．1年。结论 多模式系列治疗对老年原发性肝癌患者疗效确切,安全性亦好,是可行而有效的治疗方法;多模式系列治疗方法中,应优先采用外科治疗。