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目的:探讨原发性大肝癌的外科治疗方法。方法:回顾性分析2002年1月—2009年12月收治的180例原发性肝癌临床资料。对肝硬化、肿块大小、部位、分期和合并症进行分析。结果:180例患者均行手术治疗,其中肝细胞癌170例,胆管细胞癌7例,混合性肝癌3例。肿瘤最大径平均9(5.3～26.3)cm,合并肝硬化150例。规则性肝切除112例,非规则性肝切除68例,行第一肝门完全阻断88例,选择性半肝血流阻断62例,全肝血流阻断10例,未进行血流阻断20例;术后并发症发生率为13.89%(25/180),病死率为1.61%(3/180)。1,3,5年累积生存率分别为76.11%,48.89%,30.0%。结论:手术切除为主的综合治疗方法是治疗原发性大肝癌主要手段,难以手术切除的大肝癌在采取经皮肝动脉化疗栓塞术(TACE)后,应争取二期切除。合理选择肝血流阻断法是保证手术成功和患者术后顺利恢复的关键。
Objective: To investigate the surgical treatment of primary hepatocellular carcinoma. Methods: The clinical data of 180 patients with primary liver cancer admitted from January 2002 to December 2009 were analyzed retrospectively. Liver cirrhosis, tumor size, location, staging and comorbidities were analyzed. Results: All the 180 patients underwent surgery, including 170 cases of hepatocellular carcinoma, 7 cases of cholangiocarcinoma and 3 cases of mixed hepatocellular carcinoma. The largest diameter of tumor average 9 (5.3 ~ 26.3) cm, with cirrhosis 150 cases. Regular hepatectomy in 112 cases, irregular hepatectomy in 68 cases, the first complete hepatic portal vein occlusion in 88 cases, selective hemihepatic flow in 62 cases, total hepatic artery occlusion in 10 cases, no blood flow 20 cases were blocked. The postoperative complication rate was 13.89% (25/180) and the case fatality rate was 1.61% (3/180). The cumulative survival rates at 1, 3 and 5 years were 76.11%, 48.89% and 30.0% respectively. CONCLUSIONS: The primary surgical treatment is a major treatment for primary large hepatocellular carcinoma. Two patients with large hepatocellular carcinoma who are difficult to be surgically removed should undergo secondary resection after transcatheter arterial chemoembolization (TACE). Reasonable choice of hepatic blood flow blocking method is to ensure the success of the operation and the key to the successful recovery of patients.