Yamamoto Y
Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Chirurg. 2001 Jul;72(7):784-93. doi: 10.1007/s001040170106.
The benefits of liver resection for patients with hepatocellular carcinoma (HCC) and concomitant liver cirrhosis have been questionable due to high rates of postoperative complications. As a result of advance in surgical techniques, along with improved perioperative management and increased knowledge of the pathophysiology of liver cirrhosis, liver resection in cirrhotic patients has become a safer surgical procedure during the 1990s. This article introduces our techniques of parenchymal resection in patients with liver cirrhosis, avoiding inflow occlusion of the hepatic circulation by using a Cavitron Ultrasonic Surgical Aspirator (CUSA) and bipolar cautery that is equipped with a mechanism for channeling water at the point of cauterization. Analysis of survival rates showed that surgical resection was more advantageous than treatment such as percutaneous ethanol injection, although the discovery of multicentric carcinogenesis in livers with hepatitis C viral infection required us to reconsider surgical indications for HCC and concomitant liver cirrhosis.
由于术后并发症发生率较高，肝细胞癌（HCC）合并肝硬化患者行肝切除的获益一直存在疑问。随着手术技术的进步，以及围手术期管理的改善和对肝硬化病理生理学认识的增加，20世纪90年代肝硬化患者的肝切除已成为一种更安全的手术方式。本文介绍了我们在肝硬化患者中进行实质切除的技术，通过使用配备了在烧灼点引导水流机制的超声外科吸引器（CUSA）和双极电凝器，避免肝循环的入流阻断。生存率分析表明，手术切除比诸如经皮乙醇注射等治疗更具优势，尽管丙型肝炎病毒感染肝脏中多中心癌发生的发现要求我们重新考虑HCC合并肝硬化的手术指征。
