摘要
目的评价原发性肝癌手术切除治疗后的疗效。方法分析１９６０年１月至１９９６年９月原发性肝癌３９３２例行手术切除治疗后手术死亡率和生存率。结果比较１９６０～１９７７年（ｎ＝１８１）、１９７８～１９８９年（ｎ＝９２１）、１９９０～１９９６年（ｎ＝２８３０）三阶段，术后死亡率分别为８．８４％、０．４３％、０．３５％，而５年生存率分别为１６．０％、３０．６％、４８．６％。比较局部肝切除术（ｎ＝９０２）与规则性肝切除术（ｎ＝１１４９）表明，局部切除术手术死亡率低（０．１０％对４．７％，Ｐ＜０．０５），而５年生存率两者无明显差异（３６．１％对４０．３％，Ｐ＞０．０５）。比较大肝癌（＞５ｃｍ，ｎ＝３２２３）与≤５ｃｍ肝癌（ｎ＝７０９）和≤３ｃｍ肝癌（ｎ＝２４１）资料，１、３、５年生存率分别为６２．５％、４２．６％、２７．５％；８９．９％、８５．０％、７９．８和９５．５％、９１．７％、８５．３％。肝癌切除加门静脉（ｎ＝６５）或胆管内（ｎ＝２３）癌栓清除术治疗肝癌伴有癌栓者，术后２年生存率分别为２５．３％和３６．５％。肝癌切除加脾切除和／或门奇断流术治疗肝癌合并门静脉高压者（ｎ＝４８），术后１、２年生存率为８３．４％和７５．２?
Objective To evaluate the results of hepatectomy of primary liver cancer (PLC). Methods During Jan. 1996 Sept. 1996,3932 patients with pathologically proven primary liver cancer were treated by hepatectomy. Results Compared the 3 periods of 1960～1977( n =181),1978～1989 ( n =921), and 1990～1996 (n=2 830 ), marked improvement in prognosis was observed, 5 year survival rate being 16.0%,30.6% and 48.6%, respectively, while postoperative mortality were 8.84%,0.43% and 0.35%, respectively. With limited resection( n =903) and lobectomy( n =1149), the operative mortality was low (0.10% vs 4.7%, P <0.05) and no difference present in 5 year survival rate (36.1% vs 40.3%, P >0.05). For PLC >5cm( n =3223), the 1,3,5 year survival rate were 62.5%,42.6% and 27.5%, respectively, while those ≤5cm( n =709), they were 89.9%, 85.0% and 79.8%, respectively and for PLC ≤3cm, ( n =241) being 95.5%, 91.7% and 85.3%, respectively. The patients in late stage underweat hepatectomy tumor thrombus removal plusn portal vein ( n =65) or that in the bile duct ( n =23) gave good results. Tumor resection combined with splenectomy for treatment of PLC with portal hypertension also resulted in prolonging survival. Conclusion Early detection and limited resection instead of lobectomy for treatment of PLC were the key points decrease operative mortality. Aggressive and combined resection were also important approach to prolong the survival time.
出处
《上海医学》
CAS
CSCD
北大核心
1999年第1期19-21,共3页
Shanghai Medical Journal
关键词
原发性
肝肿瘤
外科手术
疗效
Primary liver cancer Hepatectomy Splenectomy Portal vein tumor thrombus Bile duct tumor thrombus
