肝硬化患者大肝细胞癌切除是否有益？38例研究。

Is resection for large hepatocellular carcinoma in cirrhotic patients beneficial? Study of 38 cases.

作者信息

Abdel-Wahab M, Sultan A, el-Ghawalby A, Fathy O, el-Ebidy G, Abo-Zeid M, Aboel-Enin A, Abdallah T, Fouad A, el-Fiky A, Gadel-Hak N, Ezzat F

机构信息

Gastroentrology Center, Mansoura University, Mansoura, Egypt.

出版信息

Hepatogastroenterology. 2001 May-Jun;48(39):757-61.

PMID:11462920

Abstract

BACKGROUND/AIMS: Hepatocellular carcinoma in cirrhotic patients generally carries a poor prognosis either due to recurrence or to postoperative morbidity or both. Several factors affect the prognosis of hepatocellular carcinoma resection as presence of cirrhosis of the liver, tumor diameter and tumor capsulation.

METHODOLOGY

Thirty-eight patients with large hepatocellular carcinoma greater than 5 cm with a background of cirrhotic liver were divided into two groups according to tumor diameter. Group A (n = 20) with tumors less than 10 cm in diameter, and group B (n = 18) with tumors larger than 10 cm. All patients underwent preoperative investigations including clinical laboratory tests, sonography, computed tomography, selective angiography and upper gastrointestinal endoscopy. All patients were subjected to different types of hepatic resection.

RESULTS

A significant difference in tumor size, capsulation, and operation time were recorded between the two groups, of patients. No significant difference was detected between both groups regarding sex, age, viral markers, pathologic features, and Child classification. Hospital mortality occurred in 5% versus 11.1% of both groups, respectively. Postoperative jaundice and ascitis occurred in 30%, 35% versus 44.4%, 72.0%, respectively (P < 0.005, P < 0.04). Late mortality occurred in 65% of patients in group A and in 77% of group B. Recurrence was detected in 42% of group A and 62% in group B. Recurrence after resection in capsulated tumors was significantly lower than in noncapsulated tumors in group A (P < 0.01), but not significant in group B. Also, survival rate in patients with capsulated tumors was significantly better in both groups (P < 0.01) than that with noncapsulated tumors.

CONCLUSIONS

Resection of hepatocellular carcinoma with diameter larger than 10 cm recorded bad prognosis regarding recurrence and mortality rates than tumors less than 10 cm. However, capsulated tumors gave better postoperative prognosis than noncapsulated ones.

摘要

背景/目的：肝硬化患者的肝细胞癌通常预后较差，原因在于复发、术后并发症或两者皆有。有几个因素会影响肝细胞癌切除术的预后，如肝脏硬化情况、肿瘤直径和肿瘤包膜。

方法

38例患有大于5cm的大肝细胞癌且有肝硬化背景的患者，根据肿瘤直径分为两组。A组（n = 20）肿瘤直径小于10cm，B组（n = 18）肿瘤直径大于10cm。所有患者均接受术前检查，包括临床实验室检查、超声检查、计算机断层扫描、选择性血管造影和上消化道内镜检查。所有患者均接受了不同类型的肝切除术。

结果

两组患者在肿瘤大小、包膜情况和手术时间方面存在显著差异。两组在性别、年龄、病毒标志物、病理特征和Child分级方面未检测到显著差异。两组的医院死亡率分别为5%和11.1%。术后黄疸和腹水的发生率分别为30%、35%和44.4%、72.0%（P < 0.005，P < 0.04）。A组65%的患者和B组77%的患者出现晚期死亡。A组42%的患者和B组62%的患者检测到复发。A组中包膜完整肿瘤切除术后的复发率显著低于未包膜肿瘤（P < 0.01），但B组不显著。此外，两组中包膜完整肿瘤患者的生存率均显著高于未包膜肿瘤患者（P < 0.01）。