Kaibori Masaki, Matsui Yoichi, Hijikawa Takeshi, Uchida Yoichiro, Kwon A-Hon, Kamiyama Yasuo
Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8507, Japan.
Surgery. 2006 Mar;139(3):385-94. doi: 10.1016/j.surg.2005.08.035.
The long-term outcome after resection of hepatocellular carcinoma is influenced by factors related to the tumor and the underlying liver disease. The prognosis of hepatocellular carcinoma is worse in hepatitis C virus antibody-positive patients than in hepatitis B surface antigen-positive patients. In patients with hepatitis C virus infection and hepatocellular carcinoma, the optimum extent of operative resection, i.e., limited versus anatomic, remains controversial.
Among 247 patients with hepatitis C virus infection who underwent curative resection of hepatocellular carcinoma between 1992 and 2003, 213 patients received limited resection and 34 patients had anatomic resection of at least two Couinaud subsegments with complete removal of the portal territory containing the tumor. The clinical characteristics, operative results, and long-term survival of these two groups were compared.
Although the patients receiving limited resection had significantly worse preoperative liver function than the patients undergoing anatomic resection, the postoperative liver function of the limited resection group was significantly better. The mortality and morbidity rates were not significantly different after limited and anatomic resection. Disease-free survival and overall survival were similar after both types of resection, as were the incidence and pattern of intrahepatic tumor recurrence.
In patients with hepatitis C virus infection and hepatocellular carcinoma, anatomic resection does not provide any significant benefit and should not be carried out unless it is technically necessary. In patients with a limited hepatic functional reserve, removal of the tumor with preservation of the liver parenchyma may take priority over wide resection.
肝细胞癌切除术后的长期预后受肿瘤及潜在肝脏疾病相关因素的影响。丙型肝炎病毒抗体阳性患者的肝细胞癌预后比乙型肝炎表面抗原阳性患者更差。在丙型肝炎病毒感染合并肝细胞癌的患者中，手术切除的最佳范围，即局限性切除与解剖性切除，仍存在争议。
在1992年至2003年间接受肝细胞癌根治性切除的247例丙型肝炎病毒感染患者中，213例接受了局限性切除，34例进行了至少两个Couinaud亚段的解剖性切除，并完全切除了包含肿瘤的门静脉区域。比较了这两组患者的临床特征、手术结果和长期生存率。
虽然接受局限性切除的患者术前肝功能明显比接受解剖性切除的患者差，但局限性切除组的术后肝功能明显更好。局限性切除和解剖性切除后的死亡率和发病率无显著差异。两种切除方式后的无病生存率和总生存率相似，肝内肿瘤复发的发生率和模式也相似。
在丙型肝炎病毒感染合并肝细胞癌的患者中，解剖性切除没有显著益处，除非技术上必要，否则不应进行。在肝功能储备有限的患者中，保留肝实质切除肿瘤可能优先于广泛切除。
