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背景与目的随着医疗诊断技术的提高,越来越多的小肝癌被发现,目前治疗小肝癌首选的方法仍是手术切除,但其术后复发率高达60%以上。本研究中我们对临床小肝癌进行回顾对照分析,拟探讨降低小肝癌手术切缘复发率的方法。方法回顾性分析广东省开平市中心医院和中山大学肿瘤医院在1991年1月～2003年5月间收治的283例小肝癌患者的临床病理资料。由于85%以上的肝癌患者合并不同程度肝硬化和肝储备功能不良,故以非规则性肝切除术为主。其中作肿瘤剔出术加残端切缘注射无水乙醇或无水乙醇明胶海绵创面填塞术140例(研究组);143例仅作普通常规处理(对照组)。比较两组患者的年龄、性别、肿瘤部位、肿瘤分期、Child-Pugh分期无统计学意义。结果研究组和对照组切缘1年复发率分别为21.4%和4.4%,有显著性差异(P<0.05);肝内转移/再发率分别为26.1%和24.5%,无统计学意义(P>0.05)。研究组和对照组5年总生存率分别为57.3%、52.8%(P=0.48),5年无瘤生存率分别为35.2%、36.9%(P=0.51)。两组患者术后一周内体温均在39℃以下;均无明显白细胞升高、胆漏及出血出现。结论不规则肝切除术后残端用无水乙醇明胶海绵填塞,或在残端处注射无水乙醇,对减少术后残端局部复发有一定效果,但对术后转移复发再发无作用,此法简单经济实用,便于推广应用,副作用少。
BACKGROUND & OBJECTIVE: With the improvement of medical diagnostic techniques, more and more small hepatocellular carcinomas have been found. Currently, the preferred method of treating small hepatocellular carcinoma is still surgical resection, but the recurrence rate is as high as 60%. In this study, we retrospectively analyzed the clinical small hepatocellular carcinoma, to explore ways to reduce the recurrence rate of surgical margin of small hepatocellular carcinoma. Methods The clinicopathological data of 283 patients with small hepatocellular carcinoma who were treated in Kaiping Central Hospital of Guangdong Province and Cancer Hospital of Sun Yat-sen University from January 1991 to May 2003 were retrospectively analyzed. As more than 85% of patients with liver cancer with varying degrees of cirrhosis and liver reserve dysfunction, it is mainly irregular hepatectomy. Among them, 140 cases (study group) were treated by tumor excision plus residual edge injection of anhydrous ethanol or anhydrous ethanol gelatin sponge wound packing; and 143 cases were routinely treated only (control group). The age, gender, tumor location, tumor stage and Child-Pugh stage of the two groups were not statistically significant. Results The one-year resection margin of study group and control group was 21.4% and 4.4%, respectively, with significant difference (P <0.05). The intrahepatic metastasis / recurrence rate was 26.1% and 24.5% respectively, with no statistical significance P> 0.05). The 5-year overall survival rates in study and control groups were 57.3% and 52.8%, respectively (P = 0.48). The 5-year disease-free survival rates were 35.2% and 36.9%, respectively (P = 0.51). Two groups of patients within a week after surgery were below 39 ℃ body temperature; no significant leukocytosis, bile leakage and bleeding. Conclusion Irregular hepatectomy stump with anhydrous ethanol gelatin sponge packing, or in the stump injection of ethanol, to reduce the residual stump local recurrence has some effect, but no recurrence of postoperative recurrence, This method is simple and economical and practical, easy to promote the use of less side effects.