Nagasue N, Yukaya H, Chang Y C, Yamanoi A, Kohno H, Hayashi T, Nakamura T
Second Department of Surgery, Shimane Medical University, Izumo, Japan.
Surg Gynecol Obstet. 1990 Sep;171(3):217-22.
From 1980 to 1988, 161 patients underwent total extirpation of primary hepatocellular carcinoma. There were 18 operative or hospital deaths. Recurrence of tumor was diagnosed in 69 of the remaining 143 patients during follow-up treatment with monthly serum alpha-fetoprotein measurements and imaging studies that were performed every three months. There were 61 men and eight women whose ages ranged from 33 to 78 years. The histologic factors noted were cirrhosis of the liver in 60 patients and chronic hepatitis in nine. There were multiple or diffuse recurrences (Type A) in 34 instances, one to three nodular recurrences (Type B) in 21, marginal recurrences (Type C) in 11 and a mixed form of the latter two in three instances. Two-thirds of the recurrences were found within 1.5 years and the second peak was noted between 2.0 and 2.5 years. Sex of patient, hepatitis B virus, type of tumor, capsule, extent of hepatic resection and postoperative chemotherapy did not influence the rate of recurrence, but cirrhotic livers had a significantly higher recurrence rate. A second hepatic resection was performed upon 20 patients with a five year survival rate of 26.8 per cent. Good results were obtained by chemoembolization of the hepatic artery. Prevention and adequate treatment of intrahepatic recurrence are of paramount importance in achieving better surgical results for hepatocellular carcinoma.
1980年至1988年期间，161例患者接受了原发性肝细胞癌全切术。手术或住院死亡18例。在对其余143例患者进行随访治疗期间，通过每月检测血清甲胎蛋白以及每三个月进行一次影像学检查，确诊有69例肿瘤复发。患者中男性61例，女性8例，年龄在33岁至78岁之间。观察到的组织学因素为60例肝硬化和9例慢性肝炎。34例为多发或弥漫性复发（A型），21例为1至3个结节性复发（B型），11例为边缘性复发（C型），3例为后两种情况的混合形式。三分之二的复发在1.5年内被发现，第二个高峰出现在2.0至2.5年之间。患者性别、乙肝病毒、肿瘤类型、包膜、肝切除范围及术后化疗均不影响复发率，但肝硬化肝脏的复发率明显较高。20例患者接受了二次肝切除术，五年生存率为26.8%。肝动脉化疗栓塞取得了良好效果。预防和妥善治疗肝内复发对于提高肝细胞癌手术效果至关重要。
