论文部分内容阅读
目的:探讨巨大原发性肝癌的外科治疗。方法:回顾性分析109例行手术切除治疗的巨大肝癌患者的临床资料。结果:肿瘤最大径10.5～30(14.46±3.84)cm;病灶单发92例,多发17例;肿瘤位于左肝41例,右肝63例,超过半肝5例;83例合并肝炎后肝硬化,5例肝癌破裂出血,19例合并门静脉癌栓(4例并有胆道癌栓),15例有肝门或肝周腹腔淋巴结转移;术前肝功能Child A级101例,B级8例;98例AFP>500μg/L,11例<20μg/L;临床分期IIa期2例,IIb期92例,IIIa期15例;规则切除42例,局限性肝切除67例,手术失血量400～2 200 mL;全组住院期无死亡,术后并发症82例次(75.23%);68例获随访2～72个月,肝癌破裂出血5例切除术后生存8～13个月,63例非破裂肝癌择期手术切除后1,3,5年生存率分别为44.07%,13.06%和7.84%结论:巨大肝癌切除近期效果优良,远期效果仍待提高;具备条件的巨大肝癌破裂出血可行一期切除。
Objective: To investigate the surgical treatment of huge primary liver cancer. Methods: The clinical data of 109 patients with giant hepatocellular carcinoma treated by surgical resection were retrospectively analyzed. Results: The largest diameter of tumor ranged from 10.5 to 30 (14.46 ± 3.84) cm. There were 92 cases of single lesions and 17 cases of multiple lesions. The tumors were located in 41 cases of left liver, 63 cases of right liver, 5 cases of hemihepatic liver, 83 cases of posthepatitic cirrhosis , 5 cases of ruptured hepatocellular carcinoma, 19 cases of portal vein tumor thrombus (4 cases with cholangiocarcinoma thrombus) and 15 cases of hepatic portal or peritoneal lymph node metastasis. Preoperative liver function was 101 cases in Child A class and 8 cases in B class. 98 cases of AFP> 500μg / L, 11 cases of <20μg / L; clinical stage IIa in 2 cases, IIb in 92 cases, IIIa in 15 cases; regular resection in 42 cases, limited liver resection in 67 cases, 200 mL. There were no deaths in the whole hospitalization period, 82 cases were followed-up complications (75.23%), 68 cases were followed up for 2 to 72 months, 5 cases of ruptured liver cancer survived 8 to 13 months after resection, The 1-, 3- and 5-year survival rates of patients with ruptured liver cancer after elective surgery were 44.07%, 13.06% and 7.84% respectively. Conclusion: The recent resection of giant hepatocellular carcinoma is effective and the long-term effect remains to be improved. resection.