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目的 研究大肝癌的手术切除和围术期处理技术。方法 回顾性总结分析1990年1月至2000年9月施行肝切除术的114例大肝癌病例。结果 大肝癌手术中输血量及术后并发症发生率均较小肝癌显著高,两两组间肝门阻断时间、术中出血量、术时、住院天数及病死率差异无显著性。1996-2000年所施行的大肝癌手术切除较1990-1995年而言,术中输血量、肝门阻断时间及住院天数均有明显下降。多元回归分析显示术中出血量是决定术后并发症发生率之独立的危险因素。结论 大肝癌的手术切除和围术期处理技术较前已有明显进步。只要术前准确判断肝脏储备功能及术中有效控制出血,大肝癌的切除仍是安全可行的。

Surgical excision of 114 cases of large hepatocellular carcinoma

Objective To investigate the technique of surgical excision and perioperative management of large hepatocellular carcinoma. Methods One hundred and fourteen cases of large hepatocellular carcinomas that received hepatectomies between Janunary 1990 and September 2000 were analysed retrospectively. Results The intraoperative transfusion and postoperative morbidity rate of large hepatocellular carcinomas were more than those of small ones significantly, however the portal clamping duration, intraoperative blood volume of hemorrhage, operation duration and the in-hospital mortality rate had no significant difference between the two groups. The intraoperative transfusion volume, portal clamping duration and in-hospital days of the large hepatocellular carcinomas between 1996 and 2000 were much less than those between 1990 and 1995 Multivariant regression analysis showed the intraoperative blood volume was the independent risk factor of postoperative morbidity rate. Conclusion Much progress has been made in the surgical excision and perioperative management of large hepatocellular carcinomas. The surgical excisions of large hepatocellular carcinomas are safe and feasible if the liver reserve function could be judged accurately and the intraoperative hemorrhage could be controlled effectively.