Nagasue N, Yukaya H, Chang Y C, Ogawa Y, Ota N, Kimura N, Nakamura T
Department of Surgery, Hiroshima Red Cross and Atomic Bomb Hospital, Japan.
Br J Surg. 1987 Sep;74(9):836-8. doi: 10.1002/bjs.1800740930.
During the last 6 years, 205 patients with primary hepatocellular carcinoma (HCC) were admitted to our surgical departments. Thirty-eight had HCC smaller than 3 cm in diameter. There were 34 men and 4 women with an average age of 56.5 years. All patients had underlying hepatic disease: liver cirrhosis in 35 patients and chronic active hepatitis with fibrosis in the remaining 3. Pre-operative complications included: oesophageal varices in ten, cholelithiasis in five, peptic ulcer in two, gastric cancer in one, and severe hypersplenism in one instance. A radical resection was performed in 32 cases and palliative resection in 6. Simultaneous operations were carried out for the above mentioned associated conditions: distal splenorenal shunt in six, Hassab's devascularization procedure in one, splenectomy in one, cholecystectomy in four, cholecystolithotomy in one, and partial gastrectomy in one. Four patients had postoperative complications: liver failure, rebleeding, right haemothorax, and upper gastrointestinal bleeding from acute mucosal lesion of the stomach. One patient with liver failure died in coma within 1 month. The operative and in-hospital mortality rates were 2.6 and 7.9 per cent, respectively. Survival rates during the first 4 years in 32 patients with radical hepatic resection were 89.9, 67.2, 58.8, and 58.8 per cent, respectively. We suggest that hepatic resection should be the first choice of treatment for minute HCC even in the presence of liver cirrhosis.
在过去6年中，205例原发性肝细胞癌（HCC）患者入住我们的外科科室。38例患者的HCC直径小于3 cm。其中男性34例，女性4例，平均年龄56.5岁。所有患者均有基础肝病：35例为肝硬化，其余3例为慢性活动性肝炎伴纤维化。术前并发症包括：食管静脉曲张10例，胆结石5例，消化性溃疡2例，胃癌1例，严重脾功能亢进1例。32例行根治性切除，6例行姑息性切除。针对上述相关病症同时进行了手术：6例行远端脾肾分流术，1例行哈萨布去血管化手术，1例行脾切除术，4例行胆囊切除术，1例行胆囊取石术，1例行部分胃切除术。4例患者出现术后并发症：肝衰竭、再出血、右侧血胸和胃急性黏膜病变导致的上消化道出血。1例肝衰竭患者在1个月内昏迷死亡。手术死亡率和住院死亡率分别为2.6%和7.9%。32例根治性肝切除患者前4年的生存率分别为89.9%、67.2%、58.8%和58.8%。我们认为，即使存在肝硬化，肝切除也应作为微小HCC的首选治疗方法。
