摘要
Objective: To discuss the methods and effects of serial therapies oriented by surgery in the treatment of pri- mary large liver cancers. Methods: From January 1993 to June 1999, 191 pa- tients with large liver carcinoma were treated surgi- cally. The size of tumors varied from 5.2 to 19.7 cm (mean 9.4 cm). Several types of liver resections were made in 121 patients and as a supplement, cry- osurgery was carried out for the remaining 70 pa- tients. Importable drug delivery system was institu- ted intraoperatively. Transcatheter arterial chemo- embolization (THP 30-60 mg, E-ADM 20-40 mg, CDDP 40-80 mg, MMC 10-20 mg, iodin oil 5-30 ml), percutaneous ethanol injection, bioimmunother- apy and traditional Chinese medicine were used pre- and post-operatively. CT angiography and CT dur- ing arterial portography were used to find satellite nodules. Early stage recurrences were predicted by AFPmRNA in peripheral blood. Child-Pugh's classi- fication plus branch chain amino acid/aromatic ami- no acid ratio (BCAA/AAA) was adopted in evalua- ting pre-operative liver functions. Results: Marked results were observed after serial treatments oriented by surgery. The 1-, 3- and 5- year survival rates in resection group were 75.8 %, 45.6% and 30.4%. respectively. The 1- and 3-year survival rates in cryosurgery group were 63.2 % and 37.0 %. The operative mortality was 1.57 %. Recur- rence rates were 69.2 % in AFPmRNA positive group and 33.3% in AFPmRNA negative group (P< 0.05). The BCAA/AAA ratio was lower than 1.5 in two patients who died of hepatic failure after resec- tion. Conclusions: Serial treatments with surgery as the chief modality gives satisfactory results in patients with large primary liver carcinoma. This regimen should be regarded as a main strategy to deal with large liver carcinoma. AFPmRNA in the peripheral blood, signifying a recurrence, may become a new clinical parameter. The BCAA/AAA ratio plus Child-Pugh's classification is able to evaluate more accurately liver function reserve before surgery.
Objective: To discuss the methods and effects of serial therapies oriented by surgery in the treatment of pri- mary large liver cancers. Methods: From January 1993 to June 1999, 191 pa- tients with large liver carcinoma were treated surgi- cally. The size of tumors varied from 5.2 to 19.7 cm (mean 9.4 cm). Several types of liver resections were made in 121 patients and as a supplement, cry- osurgery was carried out for the remaining 70 pa- tients. Importable drug delivery system was institu- ted intraoperatively. Transcatheter arterial chemo- embolization (THP 30-60 mg, E-ADM 20-40 mg, CDDP 40-80 mg, MMC 10-20 mg, iodin oil 5-30 ml), percutaneous ethanol injection, bioimmunother- apy and traditional Chinese medicine were used pre- and post-operatively. CT angiography and CT dur- ing arterial portography were used to find satellite nodules. Early stage recurrences were predicted by AFPmRNA in peripheral blood. Child-Pugh's classi- fication plus branch chain amino acid/aromatic ami- no acid ratio (BCAA/AAA) was adopted in evalua- ting pre-operative liver functions. Results: Marked results were observed after serial treatments oriented by surgery. The 1-, 3- and 5- year survival rates in resection group were 75.8 %, 45.6% and 30.4%. respectively. The 1- and 3-year survival rates in cryosurgery group were 63.2 % and 37.0 %. The operative mortality was 1.57 %. Recur- rence rates were 69.2 % in AFPmRNA positive group and 33.3% in AFPmRNA negative group (P< 0.05). The BCAA/AAA ratio was lower than 1.5 in two patients who died of hepatic failure after resec- tion. Conclusions: Serial treatments with surgery as the chief modality gives satisfactory results in patients with large primary liver carcinoma. This regimen should be regarded as a main strategy to deal with large liver carcinoma. AFPmRNA in the peripheral blood, signifying a recurrence, may become a new clinical parameter. The BCAA/AAA ratio plus Child-Pugh's classification is able to evaluate more accurately liver function reserve before surgery.
