肝癌的外科治疗—香港经验

肝细胞肝癌（ＨＣＣ）在香港是居于第二位的致死恶性肿瘤，肝切除是治疗ＨＣＣ最为常用和有效的方法。香港大学玛丽医院在最近９年来，肝切除术技术和围手术期管理已经逐渐形成了一套自己的常规。为了避免不必要的开腹手术，术前仔细地检查和估计肿瘤扩散的范围及病人的肝功能情况十分重要。超声刀和Ｐｒｉｎｇｌｅ技术的采用能够有效地减少术中失血，术后管理和围手术期营养支持也是重要的确保肝切除术成功的因素。玛丽医院肝切除术

SURGICAL TREATMENT FOR HEPATOCELLULAR CARCINOMA:THE HONGKONG'S EXPERIENCE

Hepatocellular carcinoma (HCC) is the second commonest killing cancer in HongKong. Hepatectomy is the commonest and most effective curative treatments for HCC. Over the last 9 years,at Queen Mary Hospital of the University of HongKong,the surgical techniques and perioperative management in hepatectomy for HCC have evolved into a standardized protocol. To avoidunnecessary laparotomy,careful preoperative evaluation of the extent of the tumour spread and the liver function are important.Uitrasonic dissector and Pringle maneuver can reduce blood loss effectively during hepatectomy. The postoperative care and perioperative nutritional support are equally important to secure success in hepatectomy. The hospital mortality rate after hepatectomy decreased from 28% in 1989 to 0% in 1996 and 1997 at Queen Mary hospital. In the last 4 years,the median blood transfusion requirement was 0ml 1 and 64% of the patients did not require blood trans fusion in hepatectomy. During the last 2 years,hospital mortalityin 110 consecutive patients was zero. On multivariate analysis,the volume of blood loss,volume of blood transfusion and operationtime are correlated postitively with postoperative morbidities. Blood transfusion,TNM staging and preoperative ICG value are majorfactors in determining tumour recurrence while the volume of blood loss,preoperative ICG value and TNM staging are the predictive factors of overall survival. Avoidance of bleeding, blood trans fusion and reducing the duration of operation should be allsurgeons endeavour in offering the patients with HCC a reasonable degree of prolongation of life.