小肝癌的临床诊断与个体化治疗

目的探讨小肝癌的临床诊断与个体化治疗方案。方法回顾性分析2007年1月至2009年1月在东莞市人民医院治疗的53例小肝癌患者的临床资料，总结小肝癌患者个体化诊治的经验。结果53例中手术切除35例，其中肿瘤位置较深而术中无法扪及18例，15例联合B超定位，3例术中体内标志联合CT／MRI定位。2例手术切除者因上消化道大出血及肝功能衰竭于术后2个月内死亡。微创治疗18例，其中射频消融术（RFA）13例，无水酒精注射术（PEI）3例，肝动脉化疗栓塞术（TA—CE）2例。手术切除组和微创治疗组3年生存率分别为75．2％和71．3％；1、2、3年复发率分别为13．3％、24．5％、37．1％和17．4％、31．8％、41．6％，差异均无统计学意义（均P〉0．05）。结论小肝癌的早期诊断应注意乙肝病史，同时结合多种检查及密切随访综合判断。术中B超和体内标志联合CT／MRI能准确定位微小病灶。小肝癌的治疗应制定个体化的治疗方案。

Clinical diagnosis and individualized treatment of small hepatocellular carcinoma

Objective To evaluate the early diagnosis and individualized treatment of small hepatocellular carcinoma（SHCC）. Methods The clinical data of 53 patients with SHCC in our hospital from 2007 to 2009 were retrospectively analyzed. The experience of early diagnosis and the individualized treatment for SHCC were summarized. Results 35 patients were treated with limited resection, 18 patients whose could not be touched received resection according to the localization by intraoperative ultrasonic testing （15 cases）, and by uniting body symbol and CT/MRI measurements during the operation（3 cases）. 2 patients whose were treated with limited resection died of upper gastrointestinal hemorrhage and liver failure in 2 months after treatment. 13 cases accepted radio-frequency ablation, 3 cases accepted percutaneous ethanol injection and 2 cases accepted transcathether arteril chemo embdization. The 3-year survival rate in the resection group and minimally invasive treatment （MIT） group was 75.2% and 71.3% , respectively. The 1-year, 2-year, and 3-year recurrence rates in resection group were 13.3%, 24.5% and 37.1% , respectively. The 1-year, 2-year, and 3-year recurrence rates in MIT group were 17.4% , 31.8% and 41.6% , respectively. The survival rate and recurrence rates were no significantly different between these two groups （ P 〉 0.05 ）. Conclusions The diagnosis of SHCC should be made taking into past history of HBV infection, various imaging findings and close follow-up. Liver tiny lesions can be accurate positioning by intraoperative ultrasonic testing, uniting body symbol and CT/MRI measurements during the operation. The SHCC treatment should be setting individualized treatment.