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=2 830)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=1 149)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( 〉5 cm,n=3 223)与≤5 cm肝癌(n=709)和≤3 cm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%。结论早期诊断、局部切除代替规则性切除术是提高肝癌切除率和降低手术死亡率的关键,对合并有门静脉(或胆管内)癌栓或合并有门静脉高压者,积极和联合手术治疗是进一步提高肝癌疗效的有效途径。
Objective To evaluate the results of hepatectomy of primary liver cancer (PLC).Methods From Jan.1996 to Sep.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 survivalrate 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 mor-tality 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 〉5 cm(n=3223),the 1,3,5-year survival rate were 62.5%,42.6% and 27.5%,respectively,while those≤5 cm(n=709),they were 89.9%,85.0% and 79.8%,respectively and for PLC≤3 cm,(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.Conclusions 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
《医学信息(手术学分册)》
2008年第1期3-5,共3页
Medical Information Operations Sciences Fascicule
关键词
原发性肝癌
肝切除术
脾切除术
门静脉癌栓
胆管癌栓
primary liver cancer
hepatectomy
splenectomy
portal vein tumor thrombus
bile duct tumor thrombus