Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, Kawasaki S
First Department of Surgery, Shinshu University, School of Medicine, Japan.
Semin Surg Oncol. 1993 Jul-Aug;9(4):298-304. doi: 10.1002/ssu.2980090404.
During the last 16 years, we have resected small hepatocellular carcinomas (HCCs) measuring 5 cm or less from 362 patients, 266 of whom also had liver cirrhosis. The operative and hospital mortality rate were 1.7% and 1.9%, respectively. These showed a gradual decrease year by year in parallel with reduction of intraoperative blood loss achieved by the selective vascular occlusion technique and Pringle method. In 1989, 87% of hepatectomy patients were discharged without the need for whole blood transfusion, and 5-year survival was 43.7%. Tumor size, number of tumors, intrahepatic metastasis, vascular invasion, and capsular invasion were significant prognostic factors. Edmondson grade and the operative procedure employed were significantly related to outcome. Our standard policy for selection of operative procedures and perioperative care is described, and the selection of treatment modalities is discussed.
在过去16年里，我们对362例患者的直径5厘米及以下的小肝细胞癌（HCC）进行了切除，其中266例患者还患有肝硬化。手术死亡率和医院死亡率分别为1.7%和1.9%。随着选择性血管阻断技术和普林格尔法使术中失血量减少，这些死亡率逐年逐渐下降。1989年，87%的肝切除患者出院时无需输注全血，5年生存率为43.7%。肿瘤大小、肿瘤数量、肝内转移、血管侵犯和包膜侵犯是重要的预后因素。埃德蒙森分级和所采用的手术操作与预后显著相关。本文描述了我们选择手术操作和围手术期护理的标准策略，并讨论了治疗方式的选择。
