Iwatsuki S, Starzl T E
Department of Surgery, University Health Center of Pittsburgh, University of Pittsburgh, Pennsylvania.
Surg Clin North Am. 1989 Apr;69(2):315-22. doi: 10.1016/s0039-6109(16)44788-2.
Our experience with hepatic resection for 106 primary hepatic malignancies has been summarized as a part of a total experience with 411 hepatic resections for various indications. The operative mortality rate (death within a month) was 8.5 per cent in treating primary hepatic malignancy, which is significantly higher than that of treating hepatic metastases (0 of 123 resections). Overall operative mortality of 411 hepatic resection was 3.2 per cent. A high operative risk was noted in patients with gross cirrhosis, trauma, abscess, and large malignant tumors. The 1-, 3-, and 5-year survival rates of patients with primary hepatic malignancy were 68.5 per cent, 45.1 per cent, and 31.9 per cent, respectively. Survival rates of patients with fibrolamellar hepatocellular carcinoma were significantly higher than those of patients with nonfibrolamellar hepatocellular carcinoma. Eighteen patients survived more than 5 years after hepatic resection, 14 of whom had been treated by trisegmentectomy. The most extensive partial hepatectomy, such as right and left trisegmentectomy rather than extended lobectomies, should be used to remove massive tumors with adequate tumor-free margins.
我们对106例原发性肝癌进行肝切除的经验，已作为对411例因各种适应证而进行肝切除的总体经验的一部分进行了总结。治疗原发性肝癌时，手术死亡率（1个月内死亡）为8.5%，这显著高于治疗肝转移瘤时的手术死亡率（123例切除术中0例死亡）。411例肝切除的总体手术死亡率为3.2%。在有明显肝硬化、创伤、脓肿和大型恶性肿瘤的患者中，手术风险较高。原发性肝癌患者的1年、3年和5年生存率分别为68.5%、45.1%和31.9%。纤维板层型肝细胞癌患者的生存率显著高于非纤维板层型肝细胞癌患者。18例患者在肝切除术后存活超过5年，其中14例接受了三段切除术。应采用最广泛的肝部分切除术，如左右三段切除术而非扩大肝叶切除术，以切除有足够切缘无瘤的大型肿瘤。
