摘要
原发性肝癌淋巴结转移是临床治疗的难点,其预后与局部晚期(IVA期)肝癌相似,但现有文献并未给出肝脏区域淋巴结分类的准确定义,亦缺乏不同部位淋巴结转移的临床资料。手术治疗肝癌淋巴结转移仍存在争议,手术技术的进步使手术安全性得到保障,可以使部分患者生存期受益,预防性淋巴结清扫可以切除影像学检查难以发现的微转移灶,但迄今未发现具有指导意义的转移相关的标记物。右半肝肝癌的区域淋巴结清扫范围主要包括切除肝十二指肠韧带、胰腺后方区域、肝总动脉旁淋巴结直到腹腔干淋巴结。左半肝肝癌需要重点清扫胃左动脉淋巴结及网膜囊淋巴结。肝癌淋巴结转移对放疗敏感,放疗剂量应控制在56Gy以内。射频消融、通过经皮经肝的淋巴系统造影术局部化疗、免疫治疗等是可以选择的综合治疗方法。
The treatment of primary liver cancer accompaning with lymph node metastasis is still one of the most challenge clinic task. It has similar prognosis with locally advanced hepatocellular carcinoma( IVA). The exact definition of regional lymph nodes related to liver is not provided in ready literatures. The clinical data of different lymph node metastasis is poor. The surgical treatment of liver cancer accompaning with lymph node metastasis is still controversial. Although survival time of some patients was able to benefit from resection without more mortality and modality,the prophylactic lymph node dissection may remove micrometastases of lymph nodes which can't be detected through preoperative imaging examination. No critical tumor marker related to lymph node metastasis is found so far. The extent of regional lymphadenectomy to right lobe hepatic cancer should include hepatoduodenal ligament,peripancreatic,periportal,along the common hepatic artery and celiac lymph nodes. As to left lobe hepatic cancer,left gastric artery and omental sac lymph nodes should be dissected. The lymph node metastasis from liver cancer is sensitive to radiotherapy so the dose should be controlled within 56Gy. Radiofrequency ablation,local chemotherapy with percutaneous transhepatic lymphography and immunotherapy are some alternative therapies.
出处
《外科研究与新技术》
2013年第3期145-148,共4页
Surgical Research and New Technique
基金
国家"十二五"科技重大专项(2012ZX10002016-014)
关键词
原发性肝癌
淋巴结转移
治疗
Primary liver cancer
Lymph node metastasis
Therapy
