手术切除联合术后TACE治疗肝细胞癌生存超10年患者53例报告

doi:10.16260/j.cnki.1009-2188.2018.02.005

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摘要目的　总结肝细胞癌(hepatocellular carcinoma, HCC)手术切除联合术后经肝动脉化学栓塞术(transcatheter arterial chemoembolization, TACE)治疗生存10年以上患者的临床经验。　方法　2000年8月～2017年4月对613例中晚期HCC行手术切除联合术后TACE治疗，其中生存10年以上患者53例(8.6%)，现回顾性分析其临床资料，其中男27例，女26例，平均年龄53(39～79)岁，41例(77.4%)有乙肝背景，39例(73.6%)合并肝硬化，术前甲胎蛋白(alpha fetal protein, AFP)阳性者44例(83.0%)，术中49例(92.5%)应用氩氦刀冷冻肝断面，肿瘤直径6～10 cm31例(58.5%)，10～15 cm 16例(30.2%)，15～20 cm 6例(11.3%)，包膜完整者46例(86.8%)，肿瘤位于左肝16例(30.2%)，右肝33例(62.3%)，中肝叶4例(7.5%)， 53例(100%)均实施肝叶段肿瘤切除术，分别于手术后1月、 2月、 3月、 6月、 9月、 12月、 18月、 24月行TACE，监测AFP变化，复查上腹部CT，其中3例(5.7%)手术后2年合并门静脉癌栓和5例(9.4%)于术后3年发生局部复发，均采用适形放疗(光子刀)治愈。结果　本组术后44例AFP阳性患者均转阴性(100%)；25例已死亡，其中15例(60%)死于肿瘤复发与肝衰竭， 4例(16%)死于消化道出血， 3例(12%)死于肺部感染及心脏意外， 3例(12%)死于泌尿系梗阻并感染，死亡时间为术后10年10例(40%)，术后12年8例(32%)，术后13年7例(28%)；目前仍存活28例中术后已生存10年者13例(46.4%)，术后11年3例(10.7%)，术后12年4例(14.3%)，术后13年3例(10.7%)，术后14年3例(10.7%)，术后15年1例(3.6%)，术后17年1例(3.6%)。结论　①手术切除联合术后TACE可有效改善HCC预后；②术中应用氩氦刀处理残肝断面以及术后针对应用适形放疗(光子刀)可能改善HCC的预后。

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	王友顺，方石岗，彭志康，黄蓉

关键词: 肝肿瘤　肝切除术　栓塞　氩氦刀　光子刀　治疗性

Abstract: Objective　To conclude the therapeutic efficacy of hepatectomy in combination with postoperative TACE for patients surviving over 10 years with hepatocellular carcinoma (HCC).　Methods　There were 613 HCC cases undergone hepatectomy combined with postoperative TACE during August, 2000 to April, 2017, in whom 53 cases survived more than 10 years, whose clinical data was analyzed retrospectively. In all the cases,41(77.4%)had hepatitis B background,39(73.6%)had hepatic cirrhosis, 44(83.0%)had AFP positive, and 49(92.5%) had used ASSS freezing hepatic remnant facet during operation. 31 cases(58.5%) with tumor diameter of 6～10cm,16(30.2%) of 10～15cm, and 6(11.3%) of 15～20 cm. 46 cases(86.8%) had complete tumor amicula. The tumor located in left liver of 16(30.2%),in right liver of 33(62.3%),and in the medial segment of 4(7.5%). 53(100%) had performed hepatic segmental resection. All the cases were performed with TACE 1, 2, 3, 6, 9, 12, 18 and 24 months after operation. AFP and upper abdominal CT were evaluated dynamically. 3(5.7%) had portal vein tumor thrombus in the 2 years following the procedure, and 5(9.4%) cases had local recurrence within 3 years after operation, which were cured by conformal therapy(photon knife).　Results　All the 44 AFP positive cases turned to negative(100%) after operation. There were 25 cases died 10 years after operation, in whom 15(60%)died from neoplasm recurrence and hepatic failure, 4(16%) died from gastrointestinal bleeding, 3(12%) died from pulmonary infection and cardiac accident, and 3(12%) died from urinary tract obstruction and infection. By the end of follow-up, the 10-, 11-, 12-, 13-, 14-,15-,17-year survival cases were 13(46.4%),3(10.7%),4(14.3%),3(10.7%),3(10.7%), 1(3.6%)and 1(3.6%).　Conclusions　①Hepatectomy in combination with postoperative TACE can effectively improve the prognosis of patients suffering from HCC. ②Using ASSS freezing hepatic remnant facet during operation and postoperative conformal therapy(photon knife)can improve the prognosis of patients suffering from HCC.

Key words: liver neoplasms 　hepatectomy 　embolization 　argon super-cryosurgery system photon knife 　therapeutic

出版日期: 2018-04-26 发布日期: 2018-08-14 期的出版日期: 2018-04-26

ZTFLH:

R735.7

通讯作者: 王友顺，男，55岁，南方医科大学珠江医院肝胆外科主任医师，教授。

作者简介: 王友顺，男，55岁，南方医科大学珠江医院肝胆外科主任医师，教授。

引用本文:

王友顺，方石岗，彭志康，黄蓉. 手术切除联合术后TACE治疗肝细胞癌生存超10年患者53例报告[J]. 中国现代手术学杂志, 2018, 22(2): 103-105.
WANG You-shun. Hepatectomy in Combination with Postoperative TACE for Patients Surviving over 10 Years with HepatocellularCarcinoma(A Report of 53 Cases). Chinese Journal of Modern Operative Surgery, 2018, 22(2): 103-105.

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