原发性大肝癌的外科治疗

目的：探讨原发性大肝癌的外科治疗方法。
方法：回顾性分析2002年1月—2009年12月收治的180例原发性肝癌临床资料。对肝硬化、肿块大小、部位、分期和合并症进行分析。
结果：180例患者均行手术治疗，其中肝细胞癌170例，胆管细胞癌7例，混合性肝癌3例。肿瘤最大径平均9（5.3~26.3）cm，合并肝硬化150例。规则性肝切除112例，非规则性肝切除68例，行第一肝门完全阻断88例，选择性半肝血流阻断62例，全肝血流阻断10例，未进行血流阻断20例；术后并发症发生率为13.89%（25/180），病死率为1.61%（3/180）。1，3，5年累积生存率分别为76.11%，48.89%，30.0%。
结论：手术切除为主的综合治疗方法是治疗原发性大肝癌主要手段，难以手术切除的大肝癌在采取经皮肝动脉化疗栓塞术（TACE）后，应争取二期切除。合理选择肝血流阻断法是保证手术成功和患者术后顺利恢复的关键。

Surgical management of large primary liver cancer

Objective: To investigate the methods of surgical treatment for large primary liver cancer (LPLC).
Methods: The clinical data of 180 patients with large LPLC admitted to our hospital from January 2002 to December 2009 were retrospectively reviewed. The presence of cirrhosis, tumor size, lesion location, clinical stage and comorbidities were analyzed.
Results: All the 180 patients underwent surgical treatment, of whom 170 cases were hepatocellular carcinoma, 7 cases were cholangiocarcinoma and 3 cases were mixed hepatic carcinoma. The average size (maximum diameter) of the tumors was 9 (5.3-26.3) cm and 150 cases were accompanied with cirrhosis. Of the patients, anatomic hepatectomy was performed in 112 cases and non-anatomic hepatectomy was performed in 68 cases; the procedures were performed with pringle maneuver in 88 cases, selective hemihepatic vascular clamping in 62 cases, total hepatic vascular exclusion in 10 cases and without hepatic vascular occlusion in 20 cases, respectively. The incidence of postoperative complications was 13.89% (25/180) and the mortality was rate 1.61% (3/180). The 1- 3- and 5-year overall survival rate of these patients was 76.11%, 48.89% and 30.0%, respectively.
Conclusion: Surgical resection-based comprehensive therapy is the main treatment method for large LPLC, and second-stage resection should be strived for after transcatheter arterial chemoembolization (TACE) for those presenting with formidable large LPLC. The rational choice of hepatic blood flow occlusion is a key to ensure operative success and smooth postoperative recovery.