摘要
１９５８年１月至１９９３年１２月经病理证实原发性肝癌共２０３０例。比较小肝癌（≤５ｃｍ，ｎ＝５１４）与大肝癌（＞５ｃｍ，ｎ＝１５１６）资料表明，小肝癌组手术切除率高（９２．２％对４９．１％）、手术死亡率低（１．７％对５．２％）、肿瘤单结节多（７８．０％对５３．４％）、肿瘤包膜完整多（７４．５％对３５．８％）、生存率高（５ａ：６３．８％对３６．６％，１０ａ：４６．８％％对２８．５％）。小肝癌作局部切除（ｎ＝４４０）与肝叶切除（ｎ＝３４），生存率无显著性差异（Ｐ＞０．０５）。小肝癌切除后复发和转移作再手术共７０例。比较１９５８～１９７０年（ｎ＝４）、１９７１～１９８２年（ｎ＝６６）、１９８３～１９９３、年ｎ＝４４４）三阶段小肝癌，疗效有所提高：５年生存率分别为２５．０％、４７．０％、６４．６％，１０年生存率分别为２５．０％、３０．３％、４７．０。小肝癌切除后生存５年以上共１２２例，生存１０年以上２４例。本文表明，手术切除是小肝癌首先治疗方法、对合并肝硬化病人作局部切除替代肝叶切除是提高切除率和降低手术死亡率的关键、对亚临床复发或转移，再手术是进一步提高疗效的途径。
During 1958-1993,2030 patients with pathologically proven primary liver cancer(PLC) were studied.Comparison between small PLC(≤5cm,n=514) and large PLC(>5cn,n=1516)revealed biger resection rate(92.2% vs 49.1%),lower operative mortality(1. 7% vs 5.2%),higher percentage of single tumor nodule (78. 0% vs 53. 4%), higher percentsge of well encapsulated tumor(74.5% vs 35.8%),and higher survival rates after resection(5year,63. 8% vs 36.6%;10year,46. 8% vs 28. 5%).No significant difference was found between survival of limited resection(n=440)and lobectomy (n= 34)in small PLC patients.Reresection of subclincal recurrence or solitary pulmonary metastasis after small PLC resection was done in 70 cases.Comparison with small PLC data of 1958-1970 (n=4),1971-1982(n=66),and 1983-1993(n=444),steady and marked improvement of the prognostic pattern was observed, 5year survival being 25.0%,47.0%,and 64. 6%,respectively, and 10year survival being 25. 0%,30.3%,and47.0%,respectively. 122 patients survived more than 5 years,24 of them surviving more than 10 years.These results indicate that resection is still the modality of choice for treatment of small PLC With compensated liver function.Limited resection instead of lobectomy was the key to increase resectability and decreaes operative mortality in cirrhotic liver. Reresection of subclinical recurrence was important to prolong survival further.
出处
《肝胆外科杂志》
1995年第1期17-19,共3页
Journal of Hepatobiliary Surgery
关键词
肝癌
小肝癌
外科手术
Liver
noplasms
early diagnosis
resection
