中晚期原发性肝癌二期切除临床若干问题初探（附37例报告）

本文对37例中晚期肝癌经肝动脉化疗栓塞(THAE)后二期切除的效果进行分析.THAE治疗后1～2个月,肿瘤直径中位数由14cm缩为7.9cm,瘤体缩小30%～88%.行规则性肝段切除或局部切陈共29例(占78.38%)、半肝切除8例(占21.60%)手术死亡率2.7%.术后6个月、1年、2年生存率(生命表法)为97.30%、89.10%、80.62%.切除标本中有癌细胞残留者占86.48%(32/37).我们初步认为:虽然THAE是当前对不能切除的中晚期肝癌治疗的首选方法,但只有不失时机地二期切除才能使部分病人得到根治的机会.因此,二期切除不仅在临床上有其必要性,而且对提高整体肝癌预后具有重大作用.二期切除的时机以栓塞后1～3个月为宜.本组91.89%(34/37)于栓塞后2个月内二期切除.

Second Stage Resection in Patients with Advanced Hepatocellular Carcinoma : A Report of 37 Cases

Thirty seven patients with advanced hepatocellular carcinoma underwent second stage resection after 1-2 months therapy of THAE when the size of tumor reduced from 14cm to 7. 9cm (median). Of these patients 29 (78. 38%)underwent regular hepatic segment resection or local resection,and 8(21. 60%)hemihepatectomy. There was one early postoperative death. The survival rates by life table method after operations were 97. 30% at 6 months,89. 10% at one year and 80. 62% at two years. Postoperative pathological examination showed that there were residual tumor cells in 32 of the 37 cases (86. 48%). The results indicated that althouth THAE is effective,second stage resection is necessary because it provides a chance of cure in some of the patients not to mention improvement of the survivals. The optimal time of the second stage operation is 1-3 months after THAE.