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近年来 ,随着影像学技术的发展 ,肝癌的早期检出率不断提高 ,小肝癌的治疗效果也不断得到改善。但是 ,合并严重肝硬化、门静脉高压的小肝癌病人常因肝功能失代偿、凝血功能障碍、食道胃底静脉曲张破裂大出血等而延误最佳治疗时机。因此 ,对此类病人治疗方法的选择和治疗时机的把握十分关键。目前 ,主要的治疗方法有小肝癌和门静脉高压的联合手术治疗、非手术治疗及肝移植等。现分述如下。1　联合手术治疗手术是小肝癌首选的治疗方法 ,已获得理想的治疗效果。我院自 196 0～ 1996年间对 70 9例直径 <5ｃｍ的小肝癌病人施行了手术切除 ,无手术…     

肝癌合并门静脉高压症的治疗选择

肝癌合并门静脉高压症病情复杂,临床治疗十分困难。治疗选择应根据引起门静脉高压的因素而采取个体化治疗。病人病情允许,适宜采用同期联合手术,但争议较多;无法耐受同期联合手术者,应选择分期手术;对于全身情况较差无手术指征的病人,原则上以非手术治疗为宜。正确掌握手术适应证,严格控制术中出血及积极防治术后并发症是有效治疗的关键。     

联合肝脏离断和门静脉结扎的二步肝切除术的争议与发展

正手术切除是肝癌的最佳治疗方式。但肝癌初始可切除率仅为15%~30%[1-2]。临床上许多肝癌病人因肿瘤巨大,导致术后剩余肝不足,无法行一期根治切除。针对这部分病人,目前手术的主要策略是诱导剩余肝增生后再行肿瘤的二步切除治疗。近年来,联合肝脏离断和门静脉结扎的二步肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)为该类病人提供了一种新的治疗选择。ALPPS可于短期内诱导剩余     

小肝癌合并严重肝硬化的治疗

近年来 ,随着影像学技术的发展 ,肝癌的早期检出率不断提高 ,小肝癌的治疗效果也不断得到改善。但是 ,合并严重肝硬化的小肝癌病人常因肝功能失代偿、凝血功能障碍、门静脉高压上消化道出血等而延误最佳治疗时机。因此 ,对此类病人治疗方法的选择和治疗时机的把握十分关键。目前 ,主要的治疗方法有手术切除、无水酒精注射、肝动脉插管化疗栓塞、射频热凝固及肝移植等。1.手术切除 :手术是小肝癌首选的治疗方法 ,已获得理想的治疗效果。上海东方肝胆外科医院在196 0～ 1996年间 ,对 70 9例直径 <5cm的小肝癌病人施行了手术切除 ,无手术死亡 ,…     

原发性肝癌与非肝癌病人行肝移植治疗的比较研究

目的：探讨我国目前肝癌与非肝癌病人行肝移植治疗的风险及长期生存效果。方法：回顾性总结21例晚期肝癌病人行肝移植手术治疗风险及长期生存情况，并与同期所行另外19例非肝癌病人的肝移植进行比较。结果：晚期肝癌病人的手术前凝血状态好于因其它非肝癌原因而接受肝移植的病人，与此相应的手术中出血量、需要输血量、术中输液总量均少于非肝癌病人，手术中因出血而导致的低血压时间短，手术后较恢复顺利，围手术期病死率低。虽然肿瘤复发所致的远期死亡率明显高于非肝癌病人，但是，总生存率与非肝癌病人无明显区别，部分病人可长期无瘤生存。结论：现阶段肝移植仍是失去根治性切除机会的肝癌病人的有效治疗手段，术后部分病人有无瘤长期生存的可能性。     

复发性肝癌治疗方式合理选择

原发性肝癌术后面临着高复发率和高转移率的问题,一直制约着病人的长期生存。针对复发性肝癌的治疗,目前主要采用以手术为主导的综合治疗方案,对于无法接受手术治疗的病人,局部消融、经导管动脉化疗栓塞、放射治疗、全身化疗、靶向治疗、免疫治疗、中药、最佳支持治疗等措施是延缓肿瘤进展、改善病人生存的有效手段。根据病人的病情特点及个体化差异,开展多学科联合治疗模式,可优化肿瘤治疗效果、减少副反应,为病人带来更好的生存质量和生存时间。     

小肝癌多学科综合治疗方式优化选择

目前,对于小肝癌可选择的治疗方法较多,其中根治性治疗方法包括肝移植、肝切除术（包括开放手术及腹腔镜手术）、局部消融治疗等。其中手术切除仍是最主要的治疗方法。随着微创外科技术的发展,腹腔镜下肝切除术已较多地运用于小肝癌病人,同时射频消融也能达到小肝癌根治的目的。在临床实践中,应注重肝癌的多学科综合治疗,根据病人肝储备功能、 肿瘤的大小和部位、 毗邻结构等情况选择治疗方式,通过对治疗方式的优化选择,可减小创伤、降低小肝癌术后复发率、提高病人长期存活率。     

63例原发性肝癌自发性破裂止血术后三种再治疗方法的比较

目的　探讨原发性肝癌自发性破裂急诊止血术后再治疗方法。方法　 63例病人随机分成三组 ,即手术探查组 ,介入化疗 +腹腔化疗组及保守治疗组 ,分别作相应处理后比较三组病人的治疗效果。结果　手术探查组术后 1年生存率达 74.1% ,高于其它二组 (P <0 .0 5 )。结论　对肝癌自发性破裂止血术后的病人 ,应根据具体情况 ,选择合适病人尽早手术探查。除对原发灶进行处理外 ,还可清除切口及腹盆腔内的种植转移灶 ,使临床疗效更好。     

原发性肝癌合并重度肝硬化的外科治疗(附78例报告)

目的 探讨原发性肝癌合并重度肝硬化外科治疗的方法及疗效。方法 自1993年1月至1999年9月共收治原发性肝癌合并重度肝硬化病人78例。术前以Child分级、ICG及BCAA／AAA评价肝脏功能，重点加强围手术期处理，术中先行脾动脉结扎，再根据肿瘤大小及部位选择手术方案，其中行肝切除术者33例，肝癌冷冻术45例。结果 78例病人术后1，2，3，4，5年生存率分别为91.0%,83.3%,60.3%,34.6%,28.2%。手术并发症为腹水及一过性黄疸。结论 原发性肝癌合并重度肝硬化病人在重视加强围手术期处理的同时行脾动脉结扎，应根据肿瘤大小及部位选择手术方案，可以有效地治疗肿瘤，避免严重的并发症，提高病人的生存质量及延长生存期。     

分化型甲状腺癌区域淋巴结清扫策略及争议

甲状腺乳头状癌颈部淋巴结转移出现早,但预后好。甲状腺切除手术和彻底合理的淋巴结清扫是公认治疗甲状腺癌的最佳选择。cN1 病人需要行颈淋巴结清扫术,但cN0 病人是否需要进行预防性中央区或颈侧区淋巴结清扫术仍有很多的争议。     

Hepatic resections for bilobar liver metastases from colorectal cancer

The present study was performed to assess survival benefits in patients who underwent a hepatic resection for isolated bilobar liver metastases from colorectal cancer. Thirty-eight patients underwent a curative hepatic resection for isolated colorectal liver metastasis. Among them, 11 patients had bilobar liver metastases and 19 had a solitary metastasis. The remaining 8 patients had unilobar multiple lesions. We investigated survival in two groups those with bilobar and those with solitary metastatic tumors. Survival and disease-free survival were 36% and 18% at 5 years, respectively, in the patients with bilobar liver metastases, while these survivals were 43% and 34% in the patients with solitary liver metastasis. In the 38 patients, repeated hepatic resections were performed in 15 patients with recurrent liver disease. The 5-year survival and disease-free survival rates for these patients were 38% and 27%, respectively, after the second hepatic resections. Of the 11 patients with bilobar liver metastases, 5 underwent a repeated hepatic resection, and they all survived for over 42 months. Based on our observations, a hepatic resection was thus found to be effective even in selected patients with either bilobar nodules or recurrence in the remnant liver. Received: February 7, 2000 / Accepted: April 26, 2000     

Surgical treatment for recurrent hepatocellular carcinoma: Current status and challenges

Primary liver cancer is the sixth most commonly diagnosed cancer and was the third leading cause of cancer deaths worldwide in 2020. It includes hepatocellular carcinoma (HCC) (representing 75%-85% of cases), intrahepatic cholangiocarcinoma (representing 10%-15% of cases), and other rare types. The survival rate of patients with HCC has risen with improved surgical technology and perioperative management in recent years; however, high tumor recurrence rates continue to limit long-term survival, even after radical surgical resection (exceeding 50% recurrence). For resectable recurrent liver cancer, surgical removal [either salvage liver transplantation (SLT) or repeat hepatic resection] remains the most effective therapy that is potentially curative for recurrent HCC. Thus, here, we introduce surgical treatment for recurrent HCC. Areas Covered: A literature search was performed for recurrent HCC using Medline and PubMed up to August 2022. Expert commentary: In general, long-term survival after the re-resection of recurrent liver cancer is usually beneficial. SLT has equivalent outcomes to primary liver transplantation for unresectable recurrent illness in a selected group of patients; however, SLT is constrained by the supply of liver grafts. SLT seems to be inferior to repeat liver resection when considering operative and postoperative results but has the major advantage of disease-free survival. When considering the similar overall survival rate and the current situation of donor shortages, repeat liver resection remains an important option for recurrent HCC.     

Long-term survival after surgical resection of liver metastasis from lung cancer

Lung cancer metastasis to the liver indicates a poor prognosis, and the majority of patients with metastatic disease to the liver are not indicated for surgery because of the number or distribution of metastases or the presence of extrahepatic disease. We herein describe a case of long-term survival after a surgical resection of liver metastases from lung cancer. Six months after surgery for Stage IB primary lung adenocarcinoma, a 71-year-old male was found to have a metastatic tumor in his liver. A hepatic resection for the metastatic tumor and another small metastatic foci found intraoperatively was carried out, and the tumors were pathologically diagnosed as liver metastases from lung cancer. The patient is presently alive and well without recurrence, as of 5 years and 2 months after the liver resection. This is the first report of the successful surgical treatment of liver metastasis from lung cancer.     

肝癌的现代综合治疗：附1320例报告

１９８６年１月至１９９５年１２月，对１３２０例肝癌病人行外科治疗，其中行各类肝切除术６８０例，肝切除术后１、３、５年生存率为９０．４％、５２．４％、３３％。术中肿瘤未能切除者均行外科综合治疗，主要包括肝动脉插管＾１２５Ｉ或＾１３１Ｉ－碘油－抗癌药物导向治疗、术中无水酒精瘤体内注入术、术后介入治疗、化疗和生物疗法等。     

A COMPARISON BETWEEN PRIMARY AND SECONDARY LIVER CANCER

Two groups of patients have been compared, one with primary liver cancer, the other with liver secondaries. The groups did not demonstrate major differences in age, sex, ethnic background or treatment methods. Although patients with secondaries showed some survival advantage during the first 612 months, any difference had disappeared by 24 months. Patients with potentially ‘curable’ lesions having hepatic resection fared significantly better than all other patients, whether their tumours were primary or secondary in the liver. For practical purposes, the two groups can be considered as having problems of comparable biological significance.     

基层医院肝切除治疗原发性肝癌35例分析

目的探讨肝切除治疗原发性肝癌的临床疗效。方法回顾性分析我院2003年4月至2005年4月35例原发性肝癌的手术治疗及随诊情况。其中右半肝切除6例,左半肝切除16例,肝中叶切除3例,单纯肝肿瘤切除10例。结果术后病理证实为肝细胞癌30例,胆管细胞癌5例。术后出血4例,再次手术出血1例,胆瘘1例,手术死亡1例,术后住院死亡1例,半年内死亡2例,1年内死亡6例,25例存活至今。结论严格掌握原发性肝癌切除手术指征及肝切除量,减少术中出血,正确处理肝创面及降低术后并发症发生率,才能保证提高手术治疗的效果。     

原发性肝癌术后复发再切除问题探讨

目的　探讨复发性肝癌发现的途径 ,再切除的路径和手术方法 ,再切除的疗效以及影响再切除肝癌预后的因素。方法　研究 5 7例肝癌术后复发的各种发现途径 ,5 7例复发性肝癌进行再切除 ,比较第一次术后的无瘤生存期、再切除术后的生存期、累积生存期以及影响预后的相关因素。结果　复发性肝癌的诊断手段为术后AFP再次升高 36例 (81.8% ) ,CT发现病灶 43例 (87.7% ) ,B超发现病灶 33例 (6 4.7% )。第一次手术后的 1,3,5 ,10年无瘤生存率分别为 6 3.9% ,38.3 % ,2 6 .6 % ,12 .8% ;再切除后的 1,3,5 ,10年生存率为 5 6 .6 % ,37.7% ,31.9% ,16 .2 % ;而 1,3,5和 10年的累积生存率分别为 82 .1% ,6 0 .8% ,47.6 % ,19.5 %。影响再切除预后的因素有肿瘤的大小、数目、复发时间、再手术切除根治与否。结论　肝癌术后AFP的监测和定期的CT检查是发现复发性肝癌的最佳途径。再切除是治疗复发性肝癌的有效方法之一。肿瘤的大小、数目、复发时间、是否有完整包膜和再手术方式都是影响复发性肝癌手术预后的因素     

Repeat hepatic resection as effective treatment for recurrent colorectal liver metastases

Background: Approximately 20–40% of patients who undergo liver resection for colorectal metastases develop recurrent disease confined to the liver. The goals of this study were to determine whether the survival benefit of repeat hepatic resection justified the potential morbidity and mortality. Methods: A retrospective review was performed on all patients who underwent liver resection for colorectal cancer metastases between 1983 and 1995 (N=202). Repeat liver resections were performed on 23 patients for recurrent metastases. Results: There were no operative deaths in the 23 patients, and the postoperative morbidity rate was 22%. The 5-year actuarial survival rate after repeat resection was 32%, with a median length of survival of 39.9 months. There were three patients who survived for >5 years after repeat resection. Sixteen patients (70%) developed recurrent disease at a median interval of 11 months after the second resection; 10 of these 16 patients (62%) had new hepatic metastases. No clinical or pathological factors were significant in predicting long-term survival. Conclusions: Repeat liver resection for recurrent colorectal metastases (a) can be performed safely with acceptable mortality and morbidity rates and (b) may result in long-term survival in some patients.Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

转移性肝癌介入治疗的疗效及影响预后的因素

目的 探讨转移性肝癌介入治疗的疗效及影响预后的因素。方法 ３６例中,原发癌灶切除者１７例,未切除者１９例,肝动脉化疗栓塞治疗１９例,肝动脉化疗药物灌注治疗者１７例。结果 原发癌灶切除组半年生存率,较未切除者具有显著性差异。肝动脉化疗栓塞治疗组半年生存率,较肝动脉化疗药物灌注治疗组,具有高度显著性差异。结论转移性肝癌患者,应尽可能切除原发癌灶,并给全身化疗,免疫治疗及原发癌灶的选择性动脉化疗药物灌注     

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目的确定继发性肝癌肝切除的适应证、方法、安全性和有效性。方法回顾分析67例继发性肝癌行肝切除69次的随访资料。结果手术死亡1例(1.5％)。其余病例分别随访1～7年,1、3、5年的生存率为28.36％、19.40％和11.94％,其中大肠癌生存＞5年者21.43％。结论肝转移疾病的外科切除,安全有效,肝转移癌病人肿瘤切除后肝功能良好,能耐受手术者应考虑手术切除。