Paquet K J, Gad H A, Lazar A, Koussouris P, Mercado M A, Heine W D, Jachman-Jahn V, Ruppert W
Department of Surgery, Heinz-Kalk-Hospital, Bad Kissingen, Germany.
Eur J Surg. 1998 Jul;164(7):513-9. doi: 10.1080/110241598750005868.
To review our policy of screening patients at risk of developing hepatocellular carcinoma (HCC), and to present 10 years' experience of hepatic resection for small HCC (< 5 cm).
Retrospective study.
Teaching hospital, Germany.
861 patients with hepatic cirrhosis and oesophageal varices of whom 151 (18%) had HCC confirmed histologically; 30 of these tumours (20%) were less than 5 cm in diameter and suitable for resection.
Segmentectomy (n = 14) bisegmentectomy (n = 10), and oncologically defined wedge resection (n = 6).
Mortality, morbidity, and survival.
4 patients died within 30 days of liver failure and sepsis (n = 20, liver failure (n = 1), and bronchopneumonia (n = 1). The main beneficial prognostic factors were Child classification, donation of autologous blood, and an encapsulated tumour. The main indicators of a poor prognosis were invasion of the liver, venous invasion, invasion of the resection margin, and the presence of microsatellite tumours and nodules. 12 of the 26 survivors developed recurrences during the first five years postoperatively (46%). Kaplan-Meier survival curves showed that survival at 1 year was 80%, at 3 years 65%, and 5 years 50%, and at 10 years 30%.
Hepatic resection is a useful treatment for small HCC, but its success depends on early detection and careful selection of patients.
回顾我们对有发生肝细胞癌（HCC）风险患者的筛查策略，并介绍小肝癌（<5 cm）肝切除术的10年经验。
回顾性研究。
德国教学医院。
861例肝硬化和食管静脉曲张患者，其中151例（18%）经组织学确诊为HCC；这些肿瘤中有30例（20%）直径小于5 cm，适合切除。
肝段切除术（n = 14）、双肝段切除术（n = 10）和肿瘤学定义的楔形切除术（n = 6）。
死亡率、发病率和生存率。
4例患者在术后30天内死于肝衰竭和败血症（n = 2）、肝衰竭（n = 1）和支气管肺炎（n = 1）。主要的有利预后因素是Child分级、自体血捐献和有包膜的肿瘤。预后不良的主要指标是肝侵犯、静脉侵犯、切缘侵犯以及微卫星肿瘤和结节的存在。26例幸存者中有12例在术后前五年出现复发（46%）。Kaplan-Meier生存曲线显示，1年生存率为80%，3年为65%，5年为50%，10年为30%。
肝切除术是小肝癌的一种有效治疗方法，但其成功取决于早期发现和患者的仔细选择。
