Franco D, Traynor O, Smadja C, Habib N
Int Surg. 1987 Apr-Jun;72(2):73-7.
Over the last five years a policy of systematic screening for small hepatocellular carcinomas (HCC) in patients at risk has led to an increasing number of resections in patients with cirrhosis. Remarkable progress in the surgery of HCC in cirrhosis has been accomplished through: (a) a better understanding of the surgical anatomy of the liver, (b) the definition of new types of liver resection aimed at reducing the amount of parenchyma removed while still being oncologically satisfactory, (c) the reduction of intraoperative blood loss by various techniques of clamping afferent and efferent vessels, (d) the systematic use of intraoperative ultrasonography, and (e) the prevention of postoperative variceal bleeding and the formation of ascites. Results of resection of small HCC in cirrhosis have been quite impressive in Japanese series, with a low operative mortality and above 50% three-year survivals. Results in the West have been somewhat less good. Differences in the pathology of these tumours and particularly in the rate of encapsulation could account for these differences. Clearly, surgical resection has become an established treatment for small HCC in cirrhosis. More information is needed on the results of surgery in operated patients and this should be compared with the natural history of small HCC in cirrhosis in order to better define the patients who will most benefit from these operations and which tests performed at which intervals, are most reliable in screening patients at risk.
在过去五年中，对高危患者进行小肝细胞癌（HCC）系统筛查的政策使得肝硬化患者的肝切除例数不断增加。通过以下方式，肝硬化患者HCC手术取得了显著进展：（a）对肝脏手术解剖结构有了更好的了解；（b）定义了新型肝切除术，旨在减少切除的实质组织量，同时在肿瘤学上仍令人满意；（c）通过各种夹闭入肝和出肝血管的技术减少术中失血；（d）系统使用术中超声检查；（e）预防术后静脉曲张出血和腹水形成。在日本的系列研究中，肝硬化患者小HCC切除的结果相当令人印象深刻，手术死亡率低，三年生存率超过50%。西方的结果则稍逊一筹。这些肿瘤的病理学差异，尤其是包膜形成率的差异，可能是造成这些差异的原因。显然，手术切除已成为肝硬化患者小HCC的既定治疗方法。需要更多关于手术患者手术结果的信息，并应将其与肝硬化患者小HCC的自然病程进行比较，以便更好地确定哪些患者将从这些手术中获益最大，以及在筛查高危患者时，哪些检查、以何种间隔进行最为可靠。
