Lui W Y, Chau G Y, Loong C C, Tsay S H, Wu J C, King K L, Chiu J H, Lai C R, P'eng F K
Department of Surgery, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan, Republic of China.
Arch Surg. 1995 Oct;130(10):1090-7. doi: 10.1001/archsurg.1995.01430100068014.
To evaluate the feasibility and results of segmentectomy for curative resection of hepatocellular carcinoma and to compare the clinicopathological findings of the patients according to the tumor location in the liver.
Case series.
A tertiary care center.
Seventy-five patients with Child's grade A or B liver function who had hepatocellular carcinoma that was confined to one segment and who underwent segmentectomy for curative resection of the tumor. The patients were divided into four groups: group P (posterior segmentectomy, n = 23); group A (anterior segmentectomy, n = 10); group M (medial segmentectomy, n = 16); and group L (lateral segmentectomy, n = 26).
Disease-free survival rate.
Seventy-three percent of the patients had cirrhosis of the liver. The surgical mortality and morbidity rates were 5.3% and 36.0%, respectively. The 1-, 3-, and 5-year disease-free survival rates were 61.9%, 39.1%, and 26.3%, respectively, and were not significantly different among the four groups (P = .86). Group L had the least operative blood loss and shortest operative time when compared with the other three groups (P < .05). The postoperative liver function changes were mild and transient in the four groups of patients. With regard to pathological factors, only tumor size differed among the groups (tumors in group L were significantly larger than those in the other three groups, P < .05). Forty-three percent of the recurrent tumors were solitary in the early stage, with 81% involving the segment(s) adjacent to the resected one and 57% being confined solely to the segment adjacent to the resected segment. Patients having recurrent hepatocellular carcinomas had significantly larger tumors at the time of resection than did those without recurrence (P = .03).
Hepatic segmentectomy is an effective therapeutic approach for small hepatocellular carcinomas and can be done safely even in patients with chronic liver disease and impaired liver function.
评估肝段切除术治疗肝细胞癌根治性切除的可行性及效果，并根据肿瘤在肝脏中的位置比较患者的临床病理特征。
病例系列研究。
三级医疗中心。
75例肝功能为Child A或B级、肝细胞癌局限于一个肝段且接受肝段切除术进行肿瘤根治性切除的患者。患者分为四组：P组（后段切除术，n = 23）；A组（前段切除术，n = 10）；M组（内侧段切除术，n = 16）；L组（外侧段切除术，n = 26）。
无病生存率。
73%的患者有肝硬化。手术死亡率和发病率分别为5.3%和36.0%。1年、3年和5年无病生存率分别为61.9%、39.1%和26.3%，四组之间差异无统计学意义（P = 0.86）。与其他三组相比，L组术中失血量最少，手术时间最短（P < 0.05）。四组患者术后肝功能变化轻微且短暂。在病理因素方面，各组间仅肿瘤大小不同（L组肿瘤明显大于其他三组，P < 0.05）。43%的复发性肿瘤在早期为孤立性，81%累及切除段相邻肝段，57%仅局限于切除段相邻肝段。复发性肝细胞癌患者切除时的肿瘤明显大于未复发患者（P = 0.03）。
肝段切除术是治疗小肝细胞癌的有效治疗方法，即使在慢性肝病和肝功能受损的患者中也可安全进行。
