肝细胞癌的外科治疗进展与争论

近10年来肝细胞癌(HCC)的外科治疗尽管有了较大进步,疗效也有了一定提高,但在治疗方法的选择上仍有许多争议。多数学者认为:HCC手术切除仍为首选。肝切除技术的改进主要是控制断肝时的出血,至今已开展了各种辅助设备的断肝。入肝血流阻断(Pringle法)下的断肝,因残肝缺血再灌注损伤或可能的残肝内远期肝癌的复发等而受到挑战。肝移植适应证也在不断扩大,许多中心已开始应用边缘供肝和活体供肝。所以缓解供肝短缺、小HCC局部毁损或手术切除仍缺乏大样本的随机对照研究结果。总之,HCC的外科治疗应严格掌握各种治疗方法的适应证,各种方法间的治疗结果仍需进行随机对照研究。

Recent Advances and Controversies in Surgical Management of Hepatocellular Carcinoma

Surgical treatment of hepatocellular carcinoma(HCC) has made great progress in recent ten years,although the appropriate selection of treatment methods remains controversial.Surgical resection of HCC is still widely recognized as the first choice,which has been remarkably improved by effectively controlling intra-operative bleeding.However,the ischemia/reperfusion injury and long-term recurrence still proposes challenges to Pringle's maneuver.The indications of liver transplantation also expand in recent years,and many centers have used marginal donor liver and living donor liver.Remission of the shortage of donors,local ablation of small HCC,and surgical resection still lack the support of randomized controlled trials.In summary,the surgical treatment of HCC should strictly based on the indications of various therapies,which should be prudently verified by randomized controlled trials.