摘要
外科手术是治疗肝癌的主要手段，30％～40％的肝癌患者可以行根治性手术切除或肝移植。近年来肝癌外科的发展已不再单纯重视外科技巧方面的改进，肝储备功能、肿瘤可切除性的精确评估、肿瘤生物学对外科治疗的影响、肿瘤复发和转移的干预等方面已成为外科领域的研究热点。
The incidence of hepatocellular carcinoma （HCC） has increased worldwide over the past two decades. Surgical resection and liver transplantation have been demonstrated as potentially curative treatment options, which could be considered in 30%-40% of HCC patients. Recent advancements of surgical treatment have focused not only on the surgical techniques, but also the hepatic functional reserve evaluation, resectability assessment and the effects of biological characteristics of tumor on prognosis. There is no single variable to evaluate the hepatic functional reserve accurately. Combined Child-Pugh classification, ICG15, portal vein pressure detection and remanent liver volume measurement are required prior to liver resection. The 5-year survival rate after liver resection for HCC is about 50%. The results are acceptable for some selected patients that underwent tumor resection with thrombectomy, including HCC with portal vein tumor thrombus or bile duct thrombosis. The choice of local resection or regular hepatectomy is still controversial although the former is commonly performed to treat HCC with cirrhosis, and the latter is applied to HCC patients without liver cirrhosis. The results of liver transplantation for HCC are better than liver resection, and the Milan criteria is generally accepted. Any attempts to expand the selection criteria should be cautious because of organ shortage. Salvage transplantation for intrahepatic recurrence after liver resection may be a good choice in some resectable HCC. The recurrence and metastasis after surgical treatment are the main obstacles to achieve better results. Identification of predictive factors could be helpful to develop prevention strategies. Due to the importance of biological characteristics in tumor recurrence and metastasis, a molecular classification to predict prognosis of HCC patients will lead to a more personalized medicine. Targeting key molecules of biological pathways could optimize the therapeutic modality in HCC.
出处
《中华消化外科杂志》
CAS
CSCD
2009年第2期94-95,共2页
Chinese Journal of Digestive Surgery
关键词
肝肿瘤
肝切除术
肝移植
Liver neoplasms
Hepateetomy
Liver transplantation
