肝切除治疗原发性肝癌的评价

报道640例原发性肝癌作肝切除术。其中局部切除317例(49.5％),左外叶切除98例(15.3％),左半肝切除160例(25.0％),扩大左半肝切除12例(1.9％),右半肝切除49例(7.7％),扩大右半肝切除4例(0.6％)。手术死亡率为5.5％。术后1、3、5、10年生存率分别为73.1％、48.9％、38.7％、28.1％;其中210例小肝癌则分别为89.7％、77.0％、63.8％、43.5％。78例术后生存5年以上,其中30例生存10年以上。对肝切除指征、手术操作及进一步提高手术远期疗效作了讨论。     

原发性肝癌二期切除八例分析

本文报道8例经手术探查证明不能切除的肝癌。行肝动脉结扎合并插管,术后经导管灌注化疗,其中5例配合内外放射或再加栓塞治疗,并应用免疫、中药等治疗方法。结果AFP均有不同程度下降,肿瘤缩小,于首次探腹术后5～14个月,获得了二期手术切除的机会。上述结果提示肝动脉结扎合并插管化疗结合内外放疗,这种序贯的、多模式的,多方法的综合治疗措施,为原先难以切除的肝癌提供了可切除的治疗途径。     

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     

大肝癌规则性肝段切除与不规则肝切除临床疗效的对比研究

从肝癌肝内转移是以门静脉系统为主这一基点出发,规则性肝段切除比不规则肝切除更具有根治性,但是在临床实践中规则性肝段切除是否可提高肝癌的无瘤生存率和总生存率尚未定论。有研究认为规则性肝段切除对小肝癌的1、3年无瘤生存率和总生存率同不规则肝切除无显著性差异,但对大肝癌实施规则性肝段切除术是否能提高术后无瘤生存率和总生存率尚未见文献报道。本文对我院收治的大肝癌肝切除病人进行分析,观察规则性肝段切除术是否可提高术后无瘤生存率和总生存率。     

原发性肝癌伴肝硬化患者的巨块肝切除─附26例分析

外科手术是治疗原发性肝癌的主要手段。在我国原发性肝癌肝硬化的伴发率为８０—９０％。由于肝脏的重要生理功能及肝硬化所致一系列病理生理紊乱，严重地限制了原发性肝癌的外科治疗，增加了手术的危险，尤其是大块肝切除时。自１９８４年至今，我们共完成肝硬化基础上的原发性肝癌的巨块肝切除２６例，右半肝切除２３例、右三叶切除３例，肝切除量均＞６０％，取得了满意的效果。     

原发性肝癌的三级根治切除标准

目的阐述原发性肝癌三级根治切除标准的内容并评价其临床意义.方法根据根治标准的完善程度将肝癌根治切除标准分为3级.Ⅰ级标准完整切除肉眼所见肿瘤,切缘无残癌.Ⅱ级标准在Ⅰ级标准基础上增加4项条件(1)肿瘤数目不超过2个;(2)无门脉主干及一级分支、总肝管及一级分支、肝静脉主干及下腔静脉癌栓;(3)无肝门淋巴结转移;(4)无肝外转移.Ⅲ级标准在Ⅱ级标准基础上增加术后随访结果阴性条件,即术后2个月内AFP降至正常(术前AFP阳性者)和影像学检查未见肿瘤残存.回顾性分析354例肝癌患者行肝切除治疗的临床资料,按3级标准的根治与否分为6组Ⅰ级标准根治组,Ⅰ级标准姑息组;Ⅱ级标准根治组,Ⅱ级标准姑息组;Ⅲ级标准根治组,Ⅲ级标准姑息组.寿命表法计算各组生存率,并加以比较.结果原发性肝癌各根治切除组生存率均高于相应姑息组(P<0.01).随着采用根治标准级别的升高,其切除后生存率也逐级提高,Ⅰ级、Ⅱ级和Ⅲ级标准根治组5年生存率分别为43.2%、51.2%和64.4%,各组生存率差异有显著性(P<0.01).结论原发性肝癌手术切除可以采用分级根治标准判定手术根治性.所应用的根治标准越严格,其获得的疗效越好.按较高级别肝癌根治切除标准选择病例、实施手术和加强随访,将提高肝癌切除手术疗效.     

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。     

腹腔镜精准肝切除治疗原发性肝癌的临床观察

目的 探讨腹腔镜精准肝切除在原发性肝癌(PHC)治疗中的应用价值。方法 选择PHC患者80例,按随机数字表法分为2组,各40例。对照组采用常规肝切除术,研究组采用腹腔镜精准肝切除术,术后随访3个月。比较2组临床疗效、手术相关指标、免疫功能及并发症。结果 2组治疗总有效率、手术时间相比,差异无统计学意义(P>0.05);研究组术中出血量(211.42±29.30)mL,低于对照组的(385.18±27.93)mL;住院时间(9.10±2.64)d,短于对照组的(12.71±2.58)d,差异有统计学意义(P<0.05)。术前,2组成熟T淋巴细胞(CD3⁺)、诱导性T细胞(CD4⁺)、CD4⁺/抑制性T细胞(CD4⁺/CD8⁺)相比,差异无统计学意义(P>0.05);术后,研究组CD3⁺、CD4⁺、CD4⁺/CD8⁺分别为(56.32±7.83)%、(26.57±5.28)%、...     

原发性肝癌伴肝硬化患者的巨块肝切除一附26例分析

外科手术是治疗原发性肝癌的主要手段。在我国原发性肝癌肝硬化的伴发率为８０－９０％，由于肝脏的重要生理功能及肝硬化所致一系列病理生理紊乱，严重地限制了原发性肝癌的外科治疗，增加了手术的危险，尤其是大块肝切除时。自１９８４年至今，我们共完成肝硬化基础上的原发性肝癌的巨块肝切除２６例，右半肝切除２３例、右三叶切除３例，肝切除量均〉６０％，取得了满意的效果。     

Short-term efficacy of precise hepatectomy and traditional hepatectomy for primary liver cancer: a systematic review and meta-analysis

BackgroundAs the base of hepatitis B patients has been increasing annually, it has developed into a high incidence source of primary liver cancer worldwide. The fatality rate of liver cancer is still relatively high. Among the many treatment methods, liver resection is the first-line treatment of primary liver cancer. Although precision hepatectomy has achieved rapid development in recent years, the understanding of its efficacy is still not completely clear. This study aimed to analyze and compare the safety and effectiveness of precision hepatectomy and traditional hepatectomy in the treatment of primary liver cancer.MethodsWe performed a literature search of the CNKI, Wanfang, Weipu.com, PubMed, Cochrane Library, Web of Science databases for studies on precision liver resection (precision group) and traditional liver resection (traditional group) for the treatment of primary liver cancer. Data including the operation time, intraoperative blood loss, hospital stay, postoperative complications, liver function, and survival rate were analyzed using RevMan 5.3 software to compare the differences in the effects of the two surgical procedures.ResultsTen articles were included in the study, involving a total of 1,969 patients, including 1,045 cases in the precision group and 924 cases in the traditional group. Meta-analysis results showed that compared with the traditional group, the precision group had a longer operation time [mean difference (MD) =8.01, P=0.004], and total bilirubin (TBiL; MD =–2.78, P=0.055) was similar. Meanwhile, the precision group exhibited advantages in terms of intraoperative blood loss (MD =–149.37, P=0.000), hospital stay (MD =–5.59, P=0.000), postoperative liver function indexes [aspartate aminotransferase (AST; MD =–11.61, P=0.000) and alanine aminotransferase (ALT; MD =–18.53, P=0.000)], postoperative complication rate [relative risk (RR) =0.51, P=0.000], and 1-year survival rate (RR =1.11, P=0.000).DiscussionThe application of precision surgery in the treatment of primary liver cancer can be a safe and effective method. It can minimize intraoperative blood loss, mitigate surgical risk, reduce postoperative complications, improve patient prognosis and quality of life, and provide better short-term curative effect and patient benefits.     

“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.     

肝切除术加化疗治疗原发性肝癌的分析

目的:探讨肝切除加化疗治疗原发性肝癌的疗效。方法:回顾性分析我院1996年1月~2003年12月收治的380例肝癌患者的临床资料,根据不同方法分成2组:手术切除组(A组)130例,手术切除加化疗组(B组)250例。结果:手术切除加化疗组1、3和5年的复发率分别为21.2%、35.1%和45.3%,其1、3和5年累积生存率分别为68.2%、50.1%和21.8%,明显高于单纯手术切除组。术后化疗次数是影响手术切除疗效的重要因素。结论:肝切除术后加区域性化疗可降低肝癌术后复发率,提高了患者的生存率。     

肝癌切除加免疫化疗对术后复发的影响

Ojbective To Study the effects of combined hepatectomy and immunochemotherapy on postoperative recurrence of primary liver cancer.Methods 121 caes were divided into four groups:operation only(OP group);combined operation and chemotherapy(OC group);combined operation and immunotherapy(OI group);combined operation and immunochemotherapy(OIC group).Chemotherapy was performed through hepatic arter or port vein,and the immunotherapy was used with LAK cell IL-2 and IFN-γ。Results Three-yeau recurrence rate in the four groups was 76.7%,55.6%,45.2% and 36.4%,respectively.The recurrence rate of OI group and OIC group was significantly lower than that of OP group.Conclusion Combined operation and immunochemotherapy in useful in preventing postoperative recurrence of primary liver cancer.     

手术切除联合术中射频在多发性肝癌患者中的应用

目的：探讨手术切除联合术中射频消融（ radiofrequency ablation,RFA）治疗多发性肝癌（ hepatocellular carcinoma,HCC）的安全性及可行性。方法：2005年1月至2014年1月,我院收治多发性肝癌（≥2个）患者42例,术前通过彩超、增强CT、MRI共发现肿瘤病灶112个,术中超声新发现肿瘤9个。手术方式包括：半肝切除7例,右肝后叶切除2例,左肝外叶切除6例,不规则肝切除27例,共切除肿瘤病灶49个。RFA处理肿瘤病灶72个。术中常规施行超声造影。结果：所有患者均成功完成手术。手术切除肿瘤时间14~45min（25.1±12.8）min。单个肿瘤病灶RFA时间9~37min（17.2±11.9）min,总RFA时间16~61min（36.4±19.2）min。总的手术时间73~189min（138.2±76.6）min。术中出血量80~1100ml（429.7±226.5）ml。无肝肾功能衰竭、胃肠及膈肌损伤等发生。术后7天开始抗病毒治疗（ HBV DNA≥5.00E＋2IU/ml）,术后1月行TACE。术后失访2例,40例随访时间为6~103月（49.2±31.8）月。对于复发病例采用再次手术切除、RFA、TACE等方法治疗。结论：手术切除联合RFA治疗多发性肝癌能最大限度保存正常肝脏组织,提高肝癌根治性切除率,有选择的实施安全可行。     

腹腔镜辅助联合肝脏离断和门静脉结扎的二步肝切除术治疗原发性肝癌的安全性和疗效评价

目的探讨腹腔镜辅助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 ）治疗原发性肝癌的安全性和疗效。方法回顾性分析2013年12月本院收治的一例巨块型肝癌患者以腹腔镜辅助ALPPS方法切除肿瘤的临床资料。第1步在腹腔镜下结扎门静脉右支并离断左肝内外叶;第2步在第1次术后第8天,评估剩余肝脏体积能满足机体要求后行右半肝的扩大切除术,同时对患者围术期的临床指标和随访资料进行分析。结果第1次手术出血50 ml,手术时长225分钟。第2次手术出血700 ml,手术时长335分钟。切除右肝三叶大小约24．0 cm×22．0 cm×15．0 cm,重量2．7 kg,肿瘤大小约18．0 cm×16．0 cm×14．0 cm,残余肝大小约15．0 cm×13．0 cm×8．0 cm。术后病理结果为原发性肝细胞癌。术后患者出现胆漏,经保守治疗后治愈。术后随访2个月,残余肝再生体积达约1200 ml,AFP降至150 ng／ml,未发现肿瘤复发转移。术后随访至32个月,再次评估残余肝再生体积达约1300 ml,AFP 16 ng／ml,未发现肿瘤复发转移,无疾病生存期达32个月。结论腹腔镜辅助ALPPS手术可作为残肝体积不足的一些较晚期肝癌患者的治疗选择。     

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...     

Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer

BACKGROUND: The prognosis of patients with liver metastasis from gastric cancer (LMGC) is dismal. The purpose of this study was to review our recent outcomes of hepatectomy for LMGC and to determine the suitable candidates for surgery. STUDY DESIGN: The outcomes of 37 patients with LMGC who underwent hepatectomy between 1990 and 2005 were assessed. No extrahepatic distant metastasis and feasibility of macroscopic curative resection were requisite indications for surgery. The prognostic values of clinicopathological factors were assessed by univariate and multivariate analyses. RESULTS: There was no in-hospital mortality. The median survival time and overall 5-year survival rate after hepatectomy of the patients with LMGC were 31 months and 11%, respectively. Intrahepatic recurrence following hepatectomy was found in 23 patients (62%). Variables independently associated with poor survival were bilobar metastasis (P = 0.002, CI = 1.9-16.3) and a maximum tumor diameter of >or= 4 cm (P = 0.006, CI = 1.4-7.7). The depth of the primary tumor and the timing of metastasis were not associated with survival. CONCLUSIONS: Surgical resection for LMGC may be indicated in patients with unilobar metastasis and/or tumors less than 4 cm in diameter. Synchronous metastasis is not a contraindication for hepatectomy.     

累及第2肝门区巨大肝癌55例手术切除体会

Objective To investigate the possibility and surgical procedures for huge liver cancer involving the second porta hepatis.Methods 55 cases of huge liver cancer, with the diameter of 8-28 cm(mean 12.7 cm) were studied. Right subcostal or “rooftop” incision was made, the liver ligments were divided, good exposure of the tumor and access to retrohepatic inferior vena cava were achieved.Hepatectomies were completed under intermittent interruption of first porta hepatis. Occluding tape around vena cava was applied before liver resection if necessary.Results All tumors were successfully resected without death during operation.The longest survival time was now 4 years in one case. The 1-4 year postoperative survival rates were 63%,50%,50% and 30% respectively.Conclusion Young patients with solitary large liver tumor, which grows slowly over a long period on basis of non-cirrhotic or mild cirrhotic liver, should undergo an exploration in an attempt of resection irrespective of the image contraindication, provided that there is no extra-hepatic metastasis.