巨大肝细胞癌的临床病理特征与手术治疗

目的 探讨巨大肝细胞癌(HCC)的临床病理特征及手术切除的安全性.方法 回顾性将中山大学附属第一医院肝胆外科2005年12月至2008年12月期间手术治疗的316例原发性肝细胞癌患者分为HCC＞10 cm(巨大肝癌)组(n=119)和HCC≤10 cm组(n=197),比较两组的临床病理资料及手术结果.结果 巨大肝癌组出现症状和阳性体征的比率、肝内转移(47/119与56/197例)、血管侵犯(58/119与47/197例)及邻近脏器侵犯(31/119与14/197例)的发生率明显高于HCC≤10 cm组;分化程度明显低于HCC≤10 cm组;术前血清天冬氨酸转氨酶[(61±45)与(56±43)U/L]、碱性磷酸酶[(152±108)与(117±100)U/L]、甲胎蛋白水平(＞400μg/L)(79/119与98/197例)明显高于HCC≤10 cm组;巨大肝癌组行大范围肝切除术的比率、术中失血量及输血量明显多于HCC≤10 cm组,手术时间(257±75)min也明显长于HCC≤10 cm组(210±74)min;但两组术后并发症发生率与死亡率无明显差异.结论 巨大肝癌具有临床表现明显、血管和邻近脏器侵犯发生率较高、分化程度较低等特征.手术切除巨大肝癌是安全、可行的.

Clinicopathological features and surgical treatment of large hepatocellular carcinoma

Objective To investigate the clinicopathological features and the safety of surgical treatment of large hepatocellular carcinoma(HCC).Methods A total of 316 HCC patients undergoing hepatectomy at our hospital from December 2005 to December 2008 were divided into HCC＞10 cm(large HCC)group(n=119)and HCC≤10 cm group(n=197).The clinicopathological data and surgical outcomes were compared between two groups.Results The HCC＞10 cm group had a higher rate of symptoms and physical findings than the HCC≤10 cm group.Compared with HCC≤10 cm group,intrahepatic metastasis,vascular invasion,adjacent organ invasion and poorly differentiated tumor were more common in HCC＞10 cm group.The preoperative serum levels of α-fetoprotein,aspartate aminotransferase and alkaline phosphatase were higher in HCC＞10 cm group.The patients with HCC＞10 cm received more major hepatectomies,suffered more intraoperative blood loss,had greater blood transfusion requirements and needed a longer operative duration.However,the incidences of postoperative complications and mortality rate were similar in two groups.Conclusion Large HCC is characterized by more clinical manifestations,higher incidences of vascular invasion and adjacent organ invasion,and worse histological grades.Surgical resection for large HCC is both safe and feasible.