Nagasue N, Kohno H, Chang Y C, Taniura H, Yamanoi A, Uchida M, Kimoto T, Takemoto Y, Nakamura T, Yukaya H
Second Department of Surgery, Shimane Medical University, Japan.
Ann Surg. 1993 Apr;217(4):375-84. doi: 10.1097/00000658-199304000-00009.
This study analyzed the results in 229 patients with primary hepatocellular carcinoma (HCC) who were treated by radical hepatic resection in the past 11 years.
Due to marked advances in diagnostic and therapeutic methods, the therapeutic strategy for HCC has changed significantly. However, there are still many problems to be solved when hepatic resection is to be performed for HCC associated with chronic liver disease. A satisfactory result may be possible only when all of accurate operative indication, skillful surgical technique, and sophisticated postoperative management are met.
There were 188 men and 41 women. Age ranged from 32 to 79 years averaging 60.8. Underlying cirrhosis of the liver was found in 177 patients, and chronic hepatitis was found in 47 instances. Before surgery, 114 patients had 157 associated conditions; diabetes mellitus in 66, esophageal varices in 42, cholelithiasis in 22, peptic ulcer in 12, and miscellaneous in 15 cases. In addition to various types of hepatic resection, 69 patients underwent concomitant operations such as cholecystectomy, the Warren shunt, splenectomy, partial gastrectomy, and so forth.
The 30-day (operative) mortality rate was 7.0%, and there were eight additional late deaths (3.5%). Child's class, bromosulphalein (BSP) test, and the estimated blood loss during surgery were good predictors for operative death. The cumulative 5- and 10-year survival rates for all patients were 26.4% and 19.4%, respectively. At present, 110 patients are alive; 2 more than 10 years and 21 more than 5 years. Younger age, absence of cirrhosis, smaller tumor, and postoperative chemotherapy were associated with increased survival.
The results of hepatic resection in 229 patients with HCC were analyzed. Child's class, BSP test, and blood loss during surgery were good predictors for operative death. The 5- and 10-year survival rates were 26.4% and 19.4%, respectively. Age, liver cirrhosis, tumor size, and postoperative chemotherapy were prognostic factors. Multidisciplinary approach with liver resection, postoperative chemotherapy, and liver transplantation will be a realistic direction for the surgical treatment of HCC in future.
本研究分析了过去11年中229例接受根治性肝切除术的原发性肝细胞癌（HCC）患者的治疗结果。
由于诊断和治疗方法的显著进步，HCC的治疗策略已发生显著变化。然而，对于伴有慢性肝病的HCC患者进行肝切除时，仍有许多问题有待解决。只有满足准确的手术指征、熟练的手术技术和完善的术后管理，才可能获得满意的结果。
男性188例，女性41例。年龄32至79岁，平均60.8岁。177例患者存在潜在的肝硬化，47例存在慢性肝炎。术前，114例患者有157种合并症；糖尿病66例，食管静脉曲张42例，胆石症22例，消化性溃疡12例，其他15例。除各种类型的肝切除外，69例患者还接受了诸如胆囊切除术、沃伦分流术、脾切除术、部分胃切除术等联合手术。
30天（手术）死亡率为7.0%，另有8例晚期死亡（3.5%）。Child分级、酚四溴酞磺酸钠（BSP）试验和手术期间估计失血量是手术死亡的良好预测指标。所有患者的5年和10年累积生存率分别为26.4%和19.4%。目前，110例患者存活；2例存活超过10年，21例存活超过5年。年龄较轻、无肝硬化、肿瘤较小和术后化疗与生存率提高相关。
分析了229例HCC患者的肝切除结果。Child分级、BSP试验和手术期间失血量是手术死亡的良好预测指标。5年和10年生存率分别为26.4%和19.4%。年龄、肝硬化、肿瘤大小和术后化疗是预后因素。肝切除、术后化疗和肝移植的多学科方法将是未来HCC手术治疗的现实方向。
