|
巨大肝细胞癌的切除 复发和疗效 |
| |
郑光琪
【摘 要】 目的 介绍用肝门区域血管阻断法切除最大径10～30cm且经病理证实的肝细胞癌96例的经验、复 发的相关因素和疗效。方法 用肝门血管解剖法游离阻断相应血管如肝右叶或右叶多亚段切除阻断肝动脉(HA)和门静脉(P V)右支(54例次)、中叶切除阻断HA和PV右前支和HA和PV左内支(19例次)、左叶切除阻断HA和 PV左支(11例次)，左外段切除阻断HA和PV左外支(15例次)。结果 ①手术死亡率3.1%；②复发率70%；③5年、3年、2年、1年生存率分别为13.5%、33.3%、 42.8%、85.1%。 结论 本法提高了巨大肝癌的切除率和手术安全性，延长了中晚期病人的生存时间，术后经泵局部 化疗2年以防治同一细胞克隆肝癌复发，干扰素注射可能预防不同细胞克隆的肝癌再生。
【关键词】 肝细胞癌 肝门
Resection，recurrence and therapeutic effect of bulky hepatocellular carcinoma.Zheng Guangqi
Department of general Surgery,First Affiliated Hospital, West China University of Medical Sciences,Chengdu 610041
【Abstract】 Objective To present the experience in resection of bulky HCC by regional vascular oc clusion at hepatic hilum,the factors related to recurrence and the therapeutic e ffect in 96 cases.Methods The correlative branches of HA and PV to the resecting hepatic lobe or segments were isolated and occluded before resection.Right branches of HA and PV were occ luded for right lobectomy or multiple subsegments resection of the right lobe(54 times),right anterior and left medial branches of HA and PV occluded for middle lobe resection(19 times),left branches of HA and PV for left lobectomy and left lateral branches of HA and PV for left lateral segmentectomy(15 times).Results Operation mortality rate was 3.1%.Recurrence rate was 70.0%.and 5,3,2,1,year s urvival rates were 13.5%,33.3%,42.8%,85.1% respectively. Conclusion Regional vascular occlusion at hepatic hilum prolongs vascular occlusion time,in c reases resectability of bulky HCC,reduces blood loss and hepatocytic mass suffer e d from ischemia during resection,improves operation safety and living time for t hese very late HCC patients.Chemotherapy via HA and PV catheterization might pre vent the recurrence from micrometastasis in 2 years after operation.Interferon injection probably could prevent the 2nd HCC from a new clone of hepatocytes.
【Key words】 Hepatocellular carcinoma[1] [2] 下一页
上一个医学论文： 二氧化碳气腹对老年人的血流动力学改变与血气影响
下一个医学论文： 肝脏与胃肠道同时存在肿块的处理原则 附12例报告
|
|
|
|
|
|
|
您现在的位置： 绿色健康网 >> 医学论文 >> 外科论文 >> 正文