Kobayashi Akira, Kawasaki Seiji, Miyagawa Shin-ichi, Miwa Shiro, Noike Terumasa, Takagi Satoshi, Iijima Satoru, Miyagawa Yusuke
First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Hepatogastroenterology. 2006 Sep-Oct;53(71):736-41.
BACKGROUND/AIMS: To evaluate our treatment protocol applied to patients with hepatocellular carcinoma. The protocol consists of the selection criteria for hepatectomy, the use of techniques that minimize intraoperative blood loss, strict follow-up after surgery, and an aggressive surgical approach for intrahepatic recurrence.
We conducted a retrospective cohort study that included 337 patients with hepatocellular carcinoma treated between 1990 and 2001. The type of resection was selected according to the serum bilirubin value and the indocyanine green retention rate at 15 minutes. Perioperative data and long-term outcome were examined.
We performed 324 initial hepatectomies with an in-hospital mortality rate close to zero. There was one operative death and one hospital death (0.3% each), and the 5-year survival rate for all patients was 53.2%. Eighty repeat liver resections, including 18 third and two fourth, were performed with no mortality, and the 5-year survival rate was 52.9% after the second hepatic resection. The resectability rate for second and third hepatectomies reached 29% and 33% of all patients with isolated liver recurrence, respectively.
Liver resection is a safe and effective treatment modality for hepatocellular carcinoma. Our results are likely attributable to the routine application of our treatment protocol.
背景/目的：评估我们应用于肝细胞癌患者的治疗方案。该方案包括肝切除的选择标准、采用尽量减少术中失血的技术、术后严格随访以及对肝内复发采取积极的手术方法。
我们进行了一项回顾性队列研究，纳入了1990年至2001年间接受治疗的337例肝细胞癌患者。根据血清胆红素值和15分钟时的吲哚菁绿潴留率选择切除类型。检查围手术期数据和长期结果。
我们进行了324例初次肝切除术，住院死亡率接近零。有1例手术死亡和1例医院死亡（各占0.3%），所有患者的5年生存率为53.2%。进行了80例再次肝切除术，包括18例第三次和2例第四次肝切除术，无死亡病例，第二次肝切除术后5年生存率为52.9%。第二次和第三次肝切除术的可切除率分别达到所有孤立性肝复发患者的29%和33%。
肝切除是治疗肝细胞癌的一种安全有效的治疗方式。我们的结果可能归因于我们治疗方案的常规应用。
