肝细胞癌切除术标准及其临床意义*

目的:阐述肝细胞癌（肝癌）切除术标准，为把握手术指征、指导治疗、提高疗效提供依据。方法:使用CNKI、NCBI生物信息学数据库，以“肝切除/liver resection 、肝癌/hepatocellular carcinoma（HCC ）”为关键词，检索已发表的文章，排除重复研究和与本研究无关文献后精选纳入分析。总结肝切除标准分类，陈述其关键因素和争议焦点，比较不同标准肝切除患者预后，讨论预后差异的可能原因。结果:HCC 切除术标准的主流分法为二分法，即根治性和姑息性切除，其关键因素包括外科、肿瘤及随访因素，肝切缘大小是否影响根治效果曾是外科因素中争论热点。近年，随着肿瘤分子生物学技术的进步，学者们对HCC 切除术标准的分法有所改变，在三分法（病理根治、临床根治和姑息切除）基础上提出HCC 切除术五分法，将病理根治划分为绝对根治（无潜在转移）和相对根治（有潜在转移），临床根治划分为有反应切除（短期内相关指标下降，如甲胎蛋白）、无反应切除（指标持续异常）和姑息性切除。根治性切除患者预后好于姑息性切除。研究显示，肝切除促进肿瘤侵袭转移潜能可能与HCC 早期播散有关，也可能与术后残余HCC 生物学特性改变相关，目前缺乏有效的干预措施。结论:根治性肝切除是目前公认的治疗HCC 患者最有效的方法之一；确定HCC 切除术标准有利于总结、分析临床资料，也有利于评估患者预后，对选择有效的治疗策略具有重要的临床意义。 

The Criteria of Hepatectomy for Hepatocellular Carcinoma and Its Clinical Significance

Objective: To demonstrate the criteria of hepatectomy for hepatocellular carcinoma (HCC) and to provide evidence for controlling indication of surgery, guiding treatment and improving therapeutic effects. Methods:Using the key-words as hepatectomy ver resection and liver neoplasms/hepatocellular carcinoma(HCC), we searched CNKI and NCBI bioinformatics databases for published articles on this topic. The literature review was done in order to summarize the crite-ria of hepatectomy for HCC and to demonstrate its key factors. The prognosis of postoperative HCC patients was com -pared and the potential causes of differential prognosis were discussed. Results: Criteria of hepatectomy for HCC patients can be broadly classified into 2 groups: curative resection group and palliative resection group. The relationship between the surgical margin and the curative effect was analyzed. With recent advances in molecular biology, researchers have ad -opted new criteria for hepatectomy. The 5- route method for HCC hepatectomy was presented based on the trichotomy of HCC (pathological curative resection, clinical curative resection，and palliative resection), including the division of pathologi -cal curative resection into absolute curative resection (without metastatic potential) and relative resection (with metastatic potential), and the division of clinical curative resection into reactive resection (related markers decreased in short duration, such as alpha fetoprotein) and non-reactive resection (persistence of aberrant markers), and palliative resection. Prognosis of HCC patients who underwent curative resection was better than that in patients treated with palliative resection. Studies showed that hepatectomy could enhance the invasive and metastatic potential of residual tumors without effective interven-tion strategies, which may be related to HCC dissemination in early stages and alteration of biological features in residual HCC induced by resection.Conclusion:As one of the most effective therapies, curative liver resection is a widely accepted treatment for HCC patients. The determination of criteria of hepatectomy is beneficial for evaluating clinical data and prognosis of HCC patients treated with surgery and for screening effective therapeutic strategies for hepatectomized patients.