预防性TACE对肝癌患者术后复发及生存的影响

目的:探讨乙型肝炎病毒(HBV)相关肝细胞癌(HCC)患者行根治性切除术后,经导管动脉化疗栓塞(TACE)对患者术后复发及生存的影响。方法:回顾性分析2009年10月至2010年8月724例在海军军医大学第三附属医院行肝癌根治性切除术患者的临床病理资料及术后复发生存资料。术后3个月内肿瘤未复发且未行TACE术的患者为对...     

术后肝血管灌注化疗预防肝癌复发

目的　评价原发性肝癌根治性切除术后肝血管灌注化疗的疗效 ,探讨肝癌切除术后复发的预防途径。方法　经病理确认的肝癌 5 4例 ,其中 3 4例行根治性切除术后肝动脉或门静脉置管化疗 ,每 4周一个疗程 ,重复 3～ 6个疗程。 2 0例根治性切除术后无任何化疗作为对照组。结果　肝血管灌注化疗组与对照组相比 ,术后1年复发率分别为 2 9.4 %和 4 0 % ,3年复发率分别为 64 .7%和 75 % ,二者有显著差异 (P <0 .0 5 )。结论　肝癌切除术后肝血管灌注化疗能预防癌复发 ,以肝动脉灌注优于门静脉 ,但二者结合效果更理想。     

原发性肝癌术后复发的再次治疗

目的：探讨原发性肝癌复发后再次手术治疗的可行性及意义。方法：选取2003年1月—2008年12月间就治和随访的58例第一次手术后复发的原发性肝癌患者,分为再手术组和消融栓塞组,比较1,3年生存率。结果：再手术组23例,均行根治性局部切除加肝动脉化疗泵植入术,术后经肝动脉化疗泵行化疗栓塞。消融栓塞组35例,均行局部射频消融治疗加股动脉穿刺肝动脉插管化疗栓塞。再手术者1,3年生存率分别为100%和82.6%,均显著高于消融栓塞组的82.9%和45.7%。结论：原发性肝癌根治性切除术后复发患者,如条件适宜,掌握好手术时机,再次手术治疗是首选方案。     

原发性肝癌术后复发与转移的非手术治疗现状与进展

原发性肝癌术后死亡的主要原因为复发与转移,肝癌根治性切除术后复发转移率高,大多数原发性肝癌术后复发转移的患者无法行二次切除术,临床上目前尚无特异性防治措施,非手术治疗显得尤为重要.包括放疗、化疗、局部消融、免疫靶向、中医中药等在内的非手术治疗方法单独或联合应用于原发性肝癌术后复发与转移的防治,在临床具有重要的作用.     

肝细胞癌破裂危险因素及其行肝切除术后临床预后分析

目的 探讨肝细胞癌(以下简称肝癌)破裂行根治性肝切除术后的独立预测因素,分析肿瘤破裂本身对肝癌接受肝切除术预后的影响.方法 回顾分析2007年4月至2011年11月海军军医大学东方肝胆外科医院和武汉大学中南医院接受肝切除治疗的106例肝癌破裂病人(破裂组)和201例肝癌病人(未破裂组)的临床病理资料,采用倾向性评分和多...     

抗病毒治疗对乙型肝炎病毒相关性肝癌根治性切除术后临床转归的影响

目的:探讨手术前后抗病毒治疗对乙型肝炎病毒(HBV)相关性肝癌根治性切除术后临床转归的影响。方法:回顾性分析135例行肝癌根治性切除术的高载量HBV相关性肝癌患者,依据手术前后是否进行抗病毒治疗分为两组:单纯行根治性切除术的患者为对照组(65例),行根治性切除术联合抗病毒治疗的患者为实验组(70例)。比较两组患者术后Child-Pugh评分、HBV DNA拷贝量、肝储备功能、术后并发症发生情况、术后无瘤生存时间的差异。结果:对照组与实验组在术后不同阶段,HBV DNA拷贝及Child-Pugh评分方面均具有明显统计学差异(P0.001);同时实验组与对照组患者术后急性肝功能衰竭(P=0.0289)、肝性脑病(P=0.0216)、肝肾综合征(P=0.0411)的发病率均具有显著统计学差异;在术后无瘤生存率方面,对照组和实验组患者1年、2年、3年无瘤生存率分别为80.0%、36.9%、13.8%和92.9%、64.3%、31.4%,1年无瘤生存率相比无明显统计学差异(P=0.2598),2年、3年无瘤生存率相比均有明显统计学差异(P=0.0015、P=0.0153),Log Rank分析可得3年总体无瘤生存率差异有统计学意义(P0.001)。结论:肝癌根治性切除术联合抗病毒治疗可以明显降低术后并发症的发生率,促进肝功能恢复,延长患者的无瘤生存期。     

3D腹腔镜与普通腹腔镜、开放根治性膀胱切除+肠道原位新膀胱术围手术期疗效的比较

目的 比较3D腹腔镜根治性膀胱切除术(3D-LRC)、腹腔镜根治性膀胱切除术(LRC)和开放根治性膀胱切除术(ORC)的疗效及围手术期并发症的发生差异.方法 回顾性分析大理白族自治州人民医院2008年9月至2020年6月行膀胱根治性切除术(RC)的患者资料,共148例,其中行ORC术62例、行LRC术32例、行3D-L...     

肝癌解剖性与非解剖性切除对患者术后近期病死率的影响

目的 探讨肝癌解剖性切除与非解剖性切除对患者术后近期病死率的影响,并分析肝癌切除术后与近期死亡相关的因素.方法 2006年8月～2009年1月,笔者行肝癌根治性切除52例,随机分为两组,甲组25例,采用解剖性肝癌切除术;乙组27例,采用非解剖性肝癌切除术.随访患者术后存活时间.结果 解剖性切除组1年病死率20.0%,非解剖性切除组1年病死率25.9%,两组间近期并发症发生人次及病死率无明显差异;但解剖性切除组术中出血量较非解剖性切除组少(P=0.006).单因素分析和多因素分析提示,肝癌门静脉癌栓与近期病死率有关(P=0.019).结论 肝癌解剖性切除与非解剖性切除对患者术后近期病死率无明显影响,肝癌门静脉癌栓可以成为预测术后早期死亡的主要因素.     

术后腹腔化疗改善胃肠癌预后的疗效观察

从手术治疗的胃肠道癌患者中,随机行腹腔化疗30例(其中根治性切除23例);随机取同期常规术后静脉化疗32例(其中根治性切除26例)作对照组。术后随访对比2年以上,结果显示:1.腹腔化疗无严重并发症,而对全身尤其对骨髓毒性作用明显较静脉化疗为小。2.两组1年或2年生存率无显著差异,但在根治性切除术后患者,腹腔化疗组2年内复发或转移率显著低于对照组(P<0.05)。作者认为,腹腔化疗简便、安全、毒副作用小而近期疗效满意。     

门静脉化疗栓塞预防肝癌切除术后复发的临床分析

目的 探讨原发性肝细胞癌切除术后,经皮经肝门静脉穿刺化疗栓塞(PVCE)预防肿瘤复发的效果.方法 回顾性分析我院2007年1月至2010年1月89例肝癌手术切除患者临床资料.其中术后进行预防性经皮经肝门静脉穿刺化疗栓塞(治疗组)41例,未行预防性门静脉化疗栓塞(对照组)48例.随访术后肿瘤复发情况,应用Kaplan-Meier方法分析两组累积无瘤生存率.组间比较用对数秩检验.采用Cox风险比例模型进行多因素分析,筛选出独立预后因素.结果 术后随访6～42个月.治疗组患者术后1年及2年无瘤生存率分别为76.5％、48.0％,对照组分别为53.8％、25.8％,差异有统计学意义(P＜0.05);平均无瘤生存期分别为19.91个月(95％CI,16.09～23.73)和13.80个月(95％ CI,10.95～16.65),治疗组累积无瘤生存率高于对照组(P=0.01).Cox模型多因素分析显示:预防性门静脉化疗栓塞、肿瘤大小、术前门静脉癌栓、术后经导管动脉化疗栓塞(TACE)是影响患者肝癌切除术后复发的独立因素.结论 肝癌切除术后经皮经肝门静脉穿刺化疗栓塞能有效预防肿瘤复发.     

Clinical Results on Intra-arterial Adjuvant Chemotherapy for Prevention of Liver Metastasis Following Curative Resection of Pancreatic Cancer

Background We report here the clinical results of intra-arterial adjuvant chemotherapy for the prevention of liver metastasis following curative resection of pancreatic carcinoma. Methods Twenty-two patients with pancreatic cancer underwent the radical operation between January 1999 and April 2005. Intra-arterial adjuvant chemotherapy with cisplatin (CDDP) and 5-fluorouracil (5FU) was selectively performed on nine patients; the remaining 13 patients did not receive chemotherapy and comprised the control group. Results Demographics and clinical characteristics were almost identical in the two groups. Liver metastasis occurred in three of nine patients (33%) in the chemotherapy group and in seven of 13 patients (54%) in the control group. The intra-arterial adjuvant chemotherapy had the tendency to suppress the rate of liver metastasis. The median survival period was 15.8 months for the nine patients who underwent the intra-arterial adjuvant chemotherapy following surgery and 13.4 months for the 13 patients of the control group who were curatively resected without the intra-arterial adjuvant chemotherapy. Cumulative survival rate was improved by the intra-arterial adjuvant chemotherapy. Conclusions In patients with pancreatic cancer who underwent the curative operation, the intra-arterial adjuvant chemotherapy had the tendency to suppress the rate of liver metastasis and improve cumulative survival.     

Laparoscopic hepatectomy for hepatocellular carcinoma

BACKGROUND: No reports exist on the role of laparoscopic hepatectomy in the short- and long-term outcomes of patients with hepatocellular carcinoma (HCC). We present our results from using laparoscopic hepatectomy for HCC and discuss the importance of this procedure. METHODS: To investigate the role of laparoscopic hepatectomy in the short- and long-term outcomes, 17 patients with HCC who underwent laparoscopic hepatectomy (laparoscopic hepatectomy group) were compared with 38 patients who underwent conventional open hepatectomy (open hepatectomy group) during the same period. RESULTS: No differences in operation time, blood loss, rate of blood transfusion, or incidence of postoperative complications were found between the two groups. The postoperative hospital stay for the laparoscopic hepatectomy group was significantly shorter than for the open hepatectomy group. With long-term prognosis, no difference was found in survival rate and disease-free survival rate between the two groups. No recurrence was found in the stump of the remaining liver after laparoscopic hepatectomy. CONCLUSIONS: Laparoscopic hepatectomy has resulted in a better short-term outcome after surgery than conventional open hepatectomy. The long-term prognosis in the laparoscopic hepatectomy group was similar to that in the open hepatectomy group. Therefore, laparoscopic hepatectomy can be a new alternative for treatment of cirrhotic patients with HCC when patients are strictly selected.     

肝癌并门静脉癌栓的外科治疗

目的:探讨术中连续门静脉灌注化疗治疗原发性肝癌并门静脉癌栓的治疗效果。方法:将38例肝癌并门静脉癌栓患者随机分为治疗组19例和对照组19例，治疗组术中实施连续门静脉灌注化疗+肝癌切除+癌栓取除术，对照组术中仅行肝癌切除+癌栓取除术。术后两组均行门静脉和/或肝动脉置管化疗。结果:A组与B组术后7 d和30 d的AFP阴性率间明显高于B组(P>0.05)，A组1，3年复发率显著低于B组(P<0.05)，1，3年生存率明显高于B组(P<0.05)。结论:术中连续门静脉灌注化疗+肝癌切除+癌栓取出术+术后门静脉和/或肝动脉置管化疗是治疗肝癌伴门静脉癌栓的一种效果较满意的方法。     

CLIP评分系统评价肝癌患者手术方式及预后

目的 探讨CLIP评分系统对可手术切除性肝癌术式选择的作用及与患者无瘤生存率的关系.方法 回顾分析1996-2004年157例行根治性肝切除肝癌患者的临床病理资料.并按CLIP评分系统0分、1分、2分和大于等于3分的标准分组,比较各组患者的无瘤生存率,比较规则性肝切除和不规则性肝切除患者的无瘤生存率.结果 本组患者1、3、5年无瘤生存率分别为63.6%、45.2%、35.7%,各组间的无瘤生存率比较差异有统计学意义(P＜0.01).在CLIP评分0分组中,行规则性肝切除与不规则性肝切除患者的术后无瘤生存率比较,差异有统计学意义(P＜0.01),其他组中规则性肝切除和不规则性肝切除患者的术后无瘤生存率差异无统计学意义(P＞0.05).结论 CLIP评分系统是评价原发性肝癌术后复发的有效工具;CLIP评分0分的肝癌患者作规则性肝切除的术后复发率远低于行不规则性肝切除.     

围手术期肝动脉栓塞化疗预防大肝癌术后复发的作用初探

目的：探讨围手术期肝动脉栓塞化疗（TACE）预防大肝癌切除术后复发的作用。方法：大肝癌切除术前4-8周（A组,n=30）、术后2-4周（B组,n=45)、术后4-6周（C组,n=30)实施TACE,同期未行TACE的大肝癌切除患者作为对照（D组,n=48)。结果：无严重手术并发症或TACE相关并发症;术后1年复发率：4组间差异显著（P＜0.025),其中B组和A组、B组和D组差异显著;6个月复发率：4组间差异显著（P＜0.005),其中B组和A组、B组和D组、C组和A组差异显著。结论：大肝癌切除术前TACE可能增加术后早期复发,不宜进行;术后2-4周早期实施TACE是预防大肝癌切除术后复发安全有效的方法。     

Risk factors for early death after liver resection in patients with solitary hepatocellular carcinoma

Background/Purpose Although most patients who receive hepatectomy for a solitary hepatocellular carcinoma (HCC) have a relatively fair result, some have a poor prognosis. The aim of this study was to evaluate the risk factors for early death after hepatectomy in patients with a solitary HCC. Methods Eligible patients (n = 110) who had undergone hepatectomy for solitary HCC between 1990 and 2002 and were able to be followed up for more than 2 years after the hepatectomy were divided into two groups, those who died of cancer recurrence within 2 years (early-death group; n = 18) and those who survived for more than 2 years after the surgery (survival group; n = 92). Risk factors for early death after liver resection were evaluated by univariate and multivariate analyses. Results The gross tumor classification, tumor diameter, macroscopic portal vein invasion, microscopic growth pattern, microscopic vascular invasion (MVI), and the width of the surgical margin were significant (P < 0.05) factors by univariate analysis. Multivariate analysis showed that the presence of MVI was an independent and significant risk factor for early death of recurrence. Conclusions Among patients with solitary HCC, the presence of MVI indicates a poor prognosis. These patients need adjuvant chemotherapy in the early period after hepatectomy.     

肝癌经导管化疗栓塞方法的疗效分析

1986—1996年对手术不能切除的肝癌83例进行了经导管化疗栓塞(TCE)治疗,并与单纯肝切除30例及肝切除术后经导管化疗(TCT)21例进行临床对比分析。TCE治疗可以增加抗癌药物疗效且副作用小。其中90％以上的肝癌肿块术后见不同程度的缩小,术后1～3年生存率与单纯肝切除病例差异无显著性,P>0.05,5例TCE治疗后行二期肝切除术。肝切除术后行TCT病例比单纯肝切除病例术后三年生存率提高,P<0.05,提示TCE治疗对不能切除的肝癌是一种有效的姑息治疗方法,肝切除术后行TCT则是一种有效的辅助治疗方法。     

Mesohepatectomy for centrally located hepatocellular carcinoma: an appraisal of a rare procedure

BACKGROUND: For centrally located hepatocellular carcinoma (HCC), extended major hepatectomy is usually recommended, but the risk of postoperative liver failure is high when liver function is not sound. Mesohepatectomy (en bloc resection of Goldsmith and Woodburne's left medial and right anterior segments or Couinaud's segments IV, V, and VIII) is a rare procedure, so its role in treating HCC is unclear. STUDY DESIGN: We retrospectively reviewed 364 patients who underwent a curative resection for HCC. Among them, 15 patients were treated by mesohepatectomy. Their nontumorous liver revealed cirrhosis in 11 and chronic hepatitis in 4. The mean tumor diameter was 12.8 cm. In 10 of the 15 patients, HCC also invaded adjacent organs. The operative results of another 25 patients with different disease extent who underwent extended major hepatectomy were compared. RESULTS: The hepatic inflow occlusion time for mesohepatectomy was longer than for extended hepatectomy (p = 0.01). The mean operative blood loss, amount of blood transfusion, operating time, and postoperative hospital stay in the mesohepatectomy group were 2,450 mL, 1,100 mL, 7.9 hours, and 14.9 days, respectively. In the extended-hepatectomy group, the values were 1,863mL, 768mL, 5.8 hours, and 16.8 days, respectively (all p>0.05 compared with mesohepatectomy). No patient died after mesohepatectomy, but after extended hepatectomy there was one death from liver failure. The Union Internationale contre le cancer (UICC) TNM stages of patients who underwent mesohepatectomy were as follows: stage II in 1, stage III in 4, and stage IVA in 10. All patients who underwent extended hepatectomy presented with stage IVA disease. The 6-year disease-free and actuarial survival rates after mesohepatectomy were 21% and 30%, respectively. The 6-year disease-free survival rate after extended hepatectomy was 9% (p = 0.11 compared with mesohepatectomy). CONCLUSION: Although mesohepatectomy is time-consuming, it is justified for selected patients with centrally located large HCC in a diseased liver.     

Surgical resection combined with chemotherapy for advanced hepatocellular carcinoma with tumor thrombus: report of 19 cases

BACKGROUND: Prognosis of hepatocellular carcinoma (HCC) with tumor thrombus in the main portal vein (MPV), inferior vena cava (IVC), or extrahepatic bile duct (EBD) treated by conventional therapies has been considered poor. This study aimed to evaluate the efficacy of hepatic arterial infusion chemotherapy after surgical resection as an adjuvant therapy or as a treatment for intrahepatic recurrence of HCC with tumor thrombus in MPV, IVC, or EBD. METHODS: Nineteen patients with HCC and tumor thrombus in the MPV, IVC, or EBD who underwent hepatectomy with thrombectomy were reviewed retrospectively. RESULTS: The overall 3-year survival rate was 48.5%. Two patients with postoperative residual tumor thrombus died within 6 months owing to rapid progression of the residual tumor thrombus. Five patients survived more than 5 years after their operations. Tumors disappeared completely in 3 patients after hepatic arterial infusion chemotherapy with a combination of cisplatinum and 5-fluorouracil, and the longest survival period was 17 years and 11 months in a patient with EBD thrombus. CONCLUSIONS: If hepatic reserve is satisfactory, an aggressive surgical approach combined with chemotherapy seems to be of benefit for patients having HCC with tumor thrombus in the MPV, IVC, or EBD.     

Postresectional Adjuvant Intraportal Chemotherapy in Patients with Hepatocellular Carcinoma: A Case-Control Study

Background The postresectional tumor recurrence rate is high in patients with hepatocellular carcinoma (HCC). Tumor portal venous invasion is the most important factor related to recurrence. Adjuvant intraportal infusion chemotherapy (IPIC) was used in HCC patients to improve the outcomes.Methods Between June 1998 and May 1999, 28 HCC patients (IPIC group) underwent postresectional IPIC daily for 2 days with 5-fluorouracil (650 mg/m²), leucovorin (45 mg/m²), doxorubicin (10 mg/m²), and cisplatin (20 mg/m²). Treatment was repeated every 3 weeks for six cycles. Patient outcomes were compared with those of 66 matched HCC patients (control group) who underwent hepatectomy without adjuvant therapy.Results The IPIC group received an average of 5.2 cycles of chemotherapy, starting 5 to 24 days after surgery. The most frequent IPIC-related adverse events were upper abdominal pain, vomiting, and myelosuppression. Five-year disease-free and overall survival rates for the IPIC group were 44.6% and 60.7%, respectively. Subgroup analysis of patients with tumor-node-metastasis stage I and II disease identified significantly lower recurrence rates for the IPIC group (33.3%) than the control group (65.0%; P = .025). For patients with stage I and II disease, 5-year disease-free and overall survival rates for the IPIC group (70.6% and 83.3%, respectively) were significantly higher than those of the control group (33.4% and 46.9%, respectively; P < .05). Patients with stage III disease do not benefit from IPIC.Conclusions Postoperative IPIC benefits HCC patients with tumor-node-metastasis stage I and II disease. The survival advantages demonstrated justify a selection of patients for future trials.