Attiyeh F F, Wichern W A
Department of Surgery, St. Luke's/Roosevelt Hospital, New York, New York.
Am J Surg. 1988 Nov;156(5):368-73. doi: 10.1016/s0002-9610(88)80188-0.
Thirty-four hepatic resections were performed on 33 patients. These included 4 trisegmentectomies, 14 lobectomies, 7 segmentectomies, and 9 wedge resections. Twenty patients had metastatic colorectal cancer, 4 had a primary liver tumor, 2 had giant cavernous hemangioma, 1 had metastatic leiomyosarcoma, 5 had various benign lesions including focal nodular hyperplasia, and 1 patient had resection for trauma. Operative morbidity included four subphrenic abscesses, one bile leak, one bile duct injury, one case of cholestasis, and one case of phlebitis. There were no operative deaths. The median survival of the patients with metastatic colorectal cancer was 40 months, and the 5-year actuarial survival rate was 35 percent. Survival rates were not significantly different between patients with a solitary metastasis and those with multiple lesions and was not influenced by size of the metastases. However, survival was significantly better in patients whose primary colorectal lesion was Dukes' B as compared with those whose lesion was Dukes' C. The results indicate that liver resection can be performed safely with acceptable morbidity and improved long-term survival.
对33例患者实施了34例肝脏切除术。其中包括4例三段切除术、14例肝叶切除术、7例肝段切除术和9例楔形切除术。20例患者患有转移性结直肠癌，4例患有原发性肝肿瘤，2例患有巨大海绵状血管瘤，1例患有转移性平滑肌肉瘤，5例患有包括局灶性结节性增生在内的各种良性病变，1例患者因创伤接受了切除术。手术并发症包括4例膈下脓肿、1例胆漏、1例胆管损伤、1例胆汁淤积和1例静脉炎。无手术死亡病例。转移性结直肠癌患者的中位生存期为40个月，5年精算生存率为35%。单发转移患者和多发转移患者的生存率无显著差异，且不受转移灶大小的影响。然而，与原发性结直肠癌病变为Dukes' C期的患者相比，病变为Dukes' B期的患者生存率明显更高。结果表明，肝脏切除术可以安全进行，并发症可接受，长期生存率得到改善。
