可切除大肝癌TACE后手术切除标本的病理研究(英文)

目的探讨可切除大肝癌 TACE 后手术切除标本的病理改变及其意义。方法 2002年1月～2003年1月收治的83例可切除大肝癌患者随机分成术前 TACE 组(36例)与一期手术组(47例),术前 TACE组31例二期切除(二期手术组),5例失去手术切除机会,78例术后病理均证实为肝细胞癌。对比两组标本间主瘤、包膜、子灶、癌栓、肝硬化等病理情况。结果 TACE 组除较一期手术组肿瘤坏死广泛、包膜更完整外,两组间子灶及门脉癌栓发生率、肝外浸润转移无显著差异;TACE 组TACE 后肿瘤体积缩小并不显著,子灶、门脉癌栓完全坏死者少,肝硬化加重。结论可切除大肝癌术前 TACE 不能使肿瘤完全坏死,部分患者耽误手术时机,应严格选择应用。

Pathological Study of Excised Specimens from Resectable Large Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization

Objective:To investigate pathological changes in surgically excised specimens from resectable large hepatocellular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE)and their significance.Methods:From January 2002 to January 2003,83 patients with resectable large HCC were randomized into two groups:group A,36 patients who underwent preoperative TACE,and group B,47 patients who underwent one-stage operation without TACE.Hepatectomy was performed in 31 patients of group A(two-stage operation group)and 47 patients of group B(one-stage operation group).The remaining 5 patients in group A were not operable.The diagnosis of HCC was pathologically confirmed in all 78 patients after hepatectomy.Pathological changes of the excised specimens between tile two groups were compared,including main tumors,capsular containment,daughter nodules,tumor thrombi and liver cirrhosis.Results:There were no significant differences in the incidence of daughter nodules,portal vein tumor thrombi(PVTT)and extrahepatic metastasis between the two groups,but the area of main tumor necrosis was more extensive and the rate of encapsulation was higher in two-stage operation group than those in one-stage operation group.No significant shrinkage in the average tumor size was seen in two- stage operation group,where daughter nodules and PVTT necrosis were less,and liver cirrhosis was more serious.Conclusion:Preoperative TACE for resectable large HCC should be used on the basis of strict selection because it does not provide complete tumor necrosis and may result in delayed surgery in some cases.