Fried M W
Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA.
Liver Transpl Surg. 1998 Sep;4(5 Suppl 1):S92-7.
Nonsurgical therapy provides some benefit to patients with advanced hepatocellular carcinoma, although surgical options, including transplantation, remain the only chance for cure. Careful patient selection is required; patients with small nodular tumors may be considered for PEI therapy, whereas patients with larger tumors may be considered for TACE. Regardless of the treatment modality, the likelihood of survival is usually directly associated with the degree of hepatic dysfunction. Randomized, controlled trials of these treatment modalities are limited in number and design; therefore, it is difficult to assess their true impact on patient survival and quality of life. Secondary chemoprophylaxis against recurrent disease with vitamin A analogues is a promising adjunctive measure to both surgical and nonsurgical treatments for hepatocellular carcinoma.
非手术治疗对晚期肝细胞癌患者有一定益处，尽管包括移植在内的手术选择仍是治愈的唯一机会。需要仔细挑选患者；小结节肿瘤患者可考虑接受经皮乙醇注射治疗（PEI），而较大肿瘤患者可考虑接受经动脉化疗栓塞术（TACE）。无论采用何种治疗方式，生存可能性通常与肝功能障碍程度直接相关。这些治疗方式的随机对照试验在数量和设计上都很有限；因此，很难评估它们对患者生存和生活质量的真正影响。用维生素A类似物进行复发性疾病的二级化学预防是肝细胞癌手术和非手术治疗都很有前景的辅助措施。
