Usatoff V, Isla A M, Habib N A
Department of Gastrointestinal Surgery, Imperial College of Science and Medicine, Liver Surgery Section, Hammersmith Hospital, London, England.
Hepatogastroenterology. 2001 Jan-Feb;48(37):46-50.
BACKGROUND/AIMS: The aim of this study was to assess the results of major liver resection in patients with advanced hepatocellular carcinoma in terms of safety and survival.
The subjects of this study are 19 patients that underwent 24 resections for advanced (stage IV) hepatocellular carcinoma. Eighteen of these resections were performed for primary tumor and 6 were repeat resections. Nine patients presented without cirrhosis, 5 with cirrhosis, and 5 patients had the fibrolamellar variant of hepatocellular carcinoma.
Hospital mortality was recorded in 1 case (5%). Morbidity was noted in 7(37%) cases. All patients with fibrolamellar variant of hepatocellular carcinoma are alive at 78, 41, 24, 12 and 9 months (P = 0.008), compared with a median survival of 18 and 9 months for the noncirrhotic hepatocellular carcinoma and cirrhotic hepatocellular carcinoma groups, respectively (P = 0.24).
We conclude that an aggressive policy of major liver resection with vascular reconstruction was justifiable in patients with advanced fibrolamellar variant of hepatocellular carcinoma and in selected patients with noncirrhotic hepatocellular carcinoma, and of doubtful value in patients with cirrhosis.
背景/目的：本研究旨在评估晚期肝细胞癌患者接受大肝切除术后的安全性及生存结果。
本研究的对象为19例接受了24次晚期（IV期）肝细胞癌切除术的患者。其中18次切除针对原发性肿瘤，6次为再次切除。9例患者无肝硬化，5例有肝硬化，5例为纤维板层型肝细胞癌。
1例（5%）患者出现医院死亡。7例（37%）患者出现并发症。所有纤维板层型肝细胞癌患者分别在78、41、24、12和9个月时仍存活（P = 0.008），相比之下，非肝硬化肝细胞癌组和肝硬化肝细胞癌组的中位生存期分别为18个月和9个月（P = 0.24）。
我们得出结论，对于晚期纤维板层型肝细胞癌患者以及部分非肝硬化肝细胞癌患者，采取积极的大肝切除联合血管重建策略是合理的，而对于肝硬化患者，该策略的价值存疑。
