论文部分内容阅读
目的 :综合分析以外科手术为中心的肝癌治疗的有关问题。方法 :以外科手术为中心 ,自 1988至1996年综合治疗原发性肝癌 2 2 3例。其中男 198例 ,女 2 5例 ,平均年龄 (49 6± 10 6 )岁 ,HBsAg(+) 16 3例 ,肝硬变 189例。TNM分期Ⅰ、Ⅱ、Ⅲ、ⅣA、ⅣB分别为 6、5 2、12 5、2 7、13例。病理类型为肝细胞癌 2 0 7例 ,胆管细胞癌 12例和混合癌 4例。结果 :全组手术死亡率为 1 8% (4 2 2 3) ,5年生存率为 4 3 3% ,其中瘤径≤ 5cm者为5 4 3% ,按根治情况则获病理根治 (81例 )为 6 1 7% ,临床根治 (75例 )为 2 2 0 % ,姑息切除 (2 6例 )为 0 %。获两种根治切除的 15 6例术后 1、3和 5年复发率为 19 8%、 4 8 2 %和 74 6 %。 5 0例肝癌术前行 1～ 5次经导管肝动脉化疗栓塞后二期切除 ,5年生存率为 4 0 5 % ,无瘤生存率仅为 2 8 9%。结论 :早期发现小肝癌和大肝癌的缩小后二期切除明显提高了肝癌切除率和远期生存率 ,但术后复发或转移率还很高。
Objective: To analyze comprehensively the problems related to the treatment of liver cancer centered on surgery. Methods: A total of 223 cases of primary liver cancer were treated from 1988 to 1996. There were 198 males and 25 females with an average age of (49 6 ± 10 6) years, 163 cases of HBsAg (+), and 189 cases of cirrhosis. TNM stage I, II, III, IVA, and IVB were 6, 5 2, 12 5, 2 7, and 13 cases, respectively. The pathological types were 270 cases of hepatocellular carcinoma, 12 cases of cholangiocellular carcinoma and 4 cases of mixed carcinoma. Results: The operative mortality rate was 1 8% (4 2 2 3) in the whole group, and the 5-year survival rate was 433%. The tumor diameter ≤ 5cm was 544%. Pathological cure was obtained according to the cure (81 cases) ) was 67.7%, clinical cure (75 cases) was 22%, and palliative resection (26 cases) was 0%. The recurrence rates at 1, 3, and 5 years after surgery for 256 cases of radical resection were 198%, 48%, and 746%. In 50 cases of hepatocellular carcinoma, 1 to 5 times of transcatheter hepatic arterial chemoembolization was performed before surgery. The 5-year survival rate was 40%, and the tumor-free survival rate was only 28.9%. Conclusion : Early detection of small secondary hepatectomy and large hepatocellular carcinoma results in a significant increase in hepatectomy and long-term survival, but the rate of recurrence or metastasis is still high.