摘要
目的探讨中央型肝癌手术切除的方法和疗效。方法回顾分析1988—2005年在我所行手术切除的257例中央型肝癌的临床资料及随访结果。按手术切除的方式将患者分为半肝切除（包括扩大半肝，n=19）和肝中叶切除（包括部分及扩大肝中叶，n=238）两组，比较手术情况及预后的差异。结果257例中央型肝癌患者术后1、3、5年生存率及无瘤生存率分别为73．4％、55．6％、41．2％和83．8％、73．8％、63．4％。Cox多因素分析提示，肿瘤大小、包膜及微血管侵犯是影响患者预后的相关因素。两种手术方式对手术时间、术后并发症、围手术期死亡、生存率及无瘤生存率的影响差异无统计学意义（P〉0．05）。结论手术切除是治疗中央型肝癌的有效手段，而对于合并有肝硬化的中央型肝癌，肝中叶切除术（包括部分及扩大肝中叶）则是首选的治疗方法。
Objective To explore the resection technique for centrally located hepatocellular carcinoma （HCC） and discuss its outcome. Methods The study reviewed 257 patients with centrally located HCC undergone liver resection from 1988 to 2005 to compare operational variables and prognosis. Of all, 238 patients were treated with mesohepatectomy （including partial or extended resection of the middle lobe, mesohepatectomy group） and 19 with extended left or right hepatectomy （extended hepatectomy group）. Results The 1-, 3- and 5-year overall survival rates of 257 patients were 73.4%, 55.6% and 41.2%, respectively; the 1-, 3- and 5-year disease-free survival rates （DFS） were 83.8% , 73.8% and 63.4%, respectively. Cox regression analysis suggested that tumor size and tumor capsule were the independent prognostic factors for overall survival, while presence of vascular invasion was the independent prognostic factor for DFS. There were no statistically significant differences upon operation time, postoperative complications, postoperative morbidity, overall survival rate and DFS between the mesohepatectomy group and the extended hepatectomy group （ P 〉0.05）. Conclusion Surgical resection is safe and effective for centrally located HCC. Mesohepatectomy is the choice of treatment for HCC complicated by liver cirrhosis.
出处
《中华消化外科杂志》
CAS
CSCD
2007年第1期8-12,共5页
Chinese Journal of Digestive Surgery
