1038例原发性肝癌的外科治疗

目的　探讨提高我国肝癌手术治疗的安全性及疗效的措施。方法　分析 1990年 1月至 1998年 12月经手术治疗的原发性肝癌 10 38例 ,其中前期组 (1990年 1月至 1996年 12月 ) 731例 ,肿瘤切除手术 312例 (42 7% ) ,非切除手术 419例 ;后期组 (1997年 1个月至 1998年 12月 ) 30 7例 ,肿瘤切除手术 2 17例 (70 7% ) ,非切除手术 90例。　结果　小肝癌 (直径≤ 5cm)前期组占 7 1% ,后期组 19 9% ;前期组肝癌切除术后 1个月内病死率 2 2 % ,并发症发生率 2 3 7% ,术后 1、3、5年生存率分别为 73 1%、5 4 2 %及 34 0 % ,后期组肝癌切除术后 1个月病死率 0 7% ,并发症发生率 2 2 1% ,术后1、3、5年生存率为 91 1%、6 3 8%及 40 2 %。　结论　 (1)对高危患者定期随访有助于早期发现小肝癌 ;(2 )小肝癌比例的上升 ,围手术期处理的进步及手术技术的改进有助于提高肝癌切除率及长期生存率 ;(3)治疗模式的规范化及新技术 ,如半肝血流阻断、体外静脉转流、门静脉癌栓摘取、原位肝移植等有助于提高手术安全性及疗效。

Surgery for patients with primary liver cancer: report of 1,038 patients

OBJECTIVE: To investigate methods for enhancing safety of and improving the survival in patients with primary liver cancer (PLC). METHODS: One thousand and thirty eight patients with PLC were treated in our hospital from January 1990 to December 1998. The early period group (from January 1990 to December 1996) consisted of 731 patients [312 patients (42.7%) receiving liver resection]; the late period group (from January 1997 to December 1998) included 307 patients [217 patients (70.7%) receiving liver resection]. RESULTS: The mortality within one month after hepatectomy was 2.24% in the early group and 0.74% in the late group. The 1-, 3- and 5-year survival rates were 73.1%, 54.2%, and 34.0% respectively in patients undergoing hepatectomy in the early group and 91.1%, 63.8% and 40.2% in the late group. CONCLUSIONS: Regular follow-up of high risk patients is helpful to discover small PLC. High proportion of small PLC, progress of perioperative management, and improvement of operative techniques including hepatopetal blood occlusion of half liver or in vitro-bypass through bio-pump during hepatectomy might be important approaches to enhance the safety of surgical treatment and improve the prognosis of patients with PLC.