区域灌注化疗后肝癌二步切除8例

目的探讨不能切除肝癌区域灌注化疗后二步切除的必要性及手术指征和手术时机、手术方式。方法回顾性分析2004年2月至2010年9月收治的不能切除的肝癌患者8例，均经肝动脉门静脉双途径区域灌注化疗后获二步切除。结果二步切除距末次灌注化疗时间为20-46（34．5±4．6）d，术前接受化疗3-6（4．2±1．6）个疗程。8例二步切除标本均查见癌细胞，并有较多的纤维组织增生。切除后肿瘤直径平均（5．6±23）cm，1、2、3年生存率为87．5％、62．5％、50．0％。结论不能切除肝癌的二步切除是提高中晚期肝癌切除率、延长生存期的有效途径。二步切除手术时机一般以3-6个疗程区域化疗后、末次治疗后1个月左右为宜。

Resection of inoperable hepatocellular cancer after regional chemoinfusion

Objective To investigate the necessity, operational indication, operation time and operation details of two-stage resection of inoperable hepatocellular cancer after regional chemoinfusion therapy. Methods From February 2004 to September 2010, eight patients with inoperable hepatocellular cancer accepted two-stage resection after regional chemoinfusion via IDDS（implanted drug-delivery system） in hepatic artery and portal vein. Results All the two-stage resections were schemed 20-46 days （average： 34.5 ± 4.6） after the last regional chemoinfusion. Patients received 3-6 preoperative regimens（average： 4.2 ± 1.6）. Cancer cells were found in all the specimens from 8 patients. The center of tumor was necrotized and became fish-like, yellow brown or dark brown, with thickened pseudo-membrane and focal cancer cells alive near the margin. The average diameter of resected cancer was （5.6 ± 2.3） cm, and the survival rates of 1-, 2-, 3-year were 87.5%, 62.5% and 50.0%. Conclusion The regional chemoinfusion therapy is an effective way to improve the rate of resection and prolong the survival time of advanced hepatocellular cancer. The twostage resection is schemed after 3-6 regimens of chemotherapy and 1 month after the last regimen.