肝细胞癌的肝切除术。对343例患者的审计。
Hepatic resection for hepatocellular carcinoma. An audit of 343 patients.
作者信息
Lai E C, Fan S T, Lo C M, Chu K M, Liu C L, Wong J
机构信息
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
出版信息
Ann Surg. 1995 Mar;221(3):291-8. doi: 10.1097/00000658-199503000-00012.
OBJECTIVE
The authors summarize the results of patients who had hepatectomy for hepatocellular carcinoma over a 22-year period.
SUMMARY BACKGROUND DATA
Recent reports showed improved perioperative results and long-term prognosis.
METHODS
The perioperative outcome of 343 patients was studied according to three different time periods: before 1987 (n = 149); 1987 to 1991 (n = 128); and 1992 to present (n = 66). Survival analysis was made by stratifying patients into two categories--either before or after 1987. The majority of patients had large tumors (78%), cirrhosis (73%), and a major hepatectomy (73%).
RESULTS
Besides an increased resectability rate (23%), there was a marked reduction of the recent morbidity (32%; p < 0.001), operative (4.5%; NS) and hospital (6%; p < 0.02) mortality rates. The recent surgical approach was identified as a significant contributory factor to the lowered hospital mortality rate. Patients in the latter part of the study had significantly better survival, with a 1-, 3- and 5-year survival rate of 68%, 45%, and 35%, respectively. Early detection and effective treatment of recurrences contributed to the improved prognosis.
CONCLUSIONS
The recent management strategy and technological advances improved the results of surgical treatment for patients with hepatocellular carcinoma.
目的
作者总结了22年间接受肝细胞癌肝切除术患者的结果。
总结背景资料
近期报告显示围手术期结果和长期预后有所改善。
方法
根据三个不同时间段研究了343例患者的围手术期结果：1987年以前（n = 149）；1987年至1991年（n = 128）；1992年至今（n = 66）。通过将患者分为1987年之前或之后两类进行生存分析。大多数患者有大肿瘤（78%）、肝硬化（73%），并接受了大肝切除术（73%）。
结果
除切除率增加（23%）外，近期发病率显著降低（32%；p < 0.001），手术死亡率（4.5%；无显著性差异）和医院死亡率（6%；p < 0.02）也显著降低。近期的手术方法被认为是降低医院死亡率的一个重要因素。研究后期的患者生存率明显更好，1年、3年和5年生存率分别为68%、45%和35%。早期发现和有效治疗复发有助于改善预后。
结论
近期的管理策略和技术进步改善了肝细胞癌患者的手术治疗结果。
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