Ikai I, Yamamoto Y, Ozaki N, Sakai Y, Shimahara Y, Yamaoka Y
Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1997 Aug;98(8):691-6.
Approximately 80% of hepatocellular carcinoma (HCC) patients in Japan have associated liver cirrhosis, which increases the difficulty of surgical treatment. Liver dysfunction associated with liver cirrhosis is one of the most important predictive prognostic factors for HCC patients. Percutaneous ethanol injection therapy (PEIT) is useful for patients with small HCC or with poor hepatic functional reserve. Transcatheter arterial chemoembolization (TACE) is also useful both for patients with unresectable HCC and patients with multiple intrahepatic recurrence. Liver resection, however, lead to better outcome than other treatments when liver function is maintained after surgery. To determine operative procedures, it is important to evaluate the exact function of remnant liver, based on the preoperative liver function test and the evaluation of tumor character. For advanced HCC patients with vascular invasion, non-surgical treatments such as PEIT or TACE are not indicated, and surgical intervention can be an effective modality to improve their survival. Improvements of surgical technique and perioperative management have decreased fatal complications at a major liver resection and allowed us to carry out liver resection on patients with advanced HCC.
在日本，约80%的肝细胞癌（HCC）患者伴有肝硬化，这增加了手术治疗的难度。与肝硬化相关的肝功能障碍是HCC患者最重要的预测预后因素之一。经皮乙醇注射疗法（PEIT）对小肝癌或肝功能储备差的患者有用。经导管动脉化疗栓塞术（TACE）对不可切除的HCC患者和肝内多发复发患者也有用。然而，当术后肝功能得以维持时，肝切除比其他治疗方法能带来更好的结果。为了确定手术方式，基于术前肝功能检查和肿瘤特征评估来准确评估残余肝脏的功能很重要。对于有血管侵犯的晚期HCC患者，不建议采用PEIT或TACE等非手术治疗，手术干预可能是提高其生存率的有效方式。手术技术和围手术期管理的改进降低了大肝切除时的致命并发症，并使我们能够对晚期HCC患者进行肝切除。
