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目的总结特大肝癌的手术治疗方法。方法回顾性总结近5年来手术治疗直径大于15cm的肝脏肿瘤17例。结果17例中,男13例,女4例:平均年龄47.3岁(31-71岁);原发性肝癌14例(高分化2例,中分化9例,低分化3例),肝恶性血管内皮瘤1例,肝脂肪瘤恶性变1例,肝血管平滑肌脂肪瘤1例。最大达27cm×21cm×13cm,重量达4.2kg;占肝段最多达4、7、8段及部分2、3段。17例中,肝功能Child A级11例,Child B级5例,Child C级1例。术中出血量最少200m l,未输血;出血最多达4600ml,平均出血量为1200m l。围手术期死亡1例,一年内死亡3例,一年生存率为82.3%。17例中,13例采用逆行切除。结论[1]本组围手术死亡1例,一年内死亡3例,一年生存率为82.3%,说明特大肝脏肿瘤的切除是安全和可行的。[2]17例中,13例采用逆行切除,该方法便于手术操做。[3]肝肿块之所以能长到如此巨大,即使是肝癌,也大部分有包膜,没有早期转移,更何况良性或良性肿瘤恶变者,因此肿瘤特大并不是手术的禁忌症,一旦能切除往往也能获得较高的生存率。因此对于特大肝脏肿瘤,手术治疗应持积极态度。
Objective To summarize the surgical treatment of extra-large liver cancer. Methods A retrospective review of 17 cases of liver tumors larger than 15 cm in diameter during the last 5 years. Results Of the 17 patients, 13 were males and 4 were females with an average age of 47.3 years (range, 31-71 years). There were 14 cases of primary hepatocellular carcinoma (2 cases of well-differentiated, 9 cases of moderately differentiated, 3 cases of poorly differentiated) 1 case of endothelioma, 1 case of malignant transformation of hepatocellular carcinoma and 1 case of hepatic angiomyolipoma. Up to 27cm × 21cm × 13cm, weighing up to 4.2kg; accounting for liver up to 4,7,8 and some 2,3 sections. In 17 cases, there were 11 Child A grades, 5 Child B grades and 1 Child C grade. Intraoperative blood loss of at least 200m l, no blood transfusion; bleeding up to 4600ml, the average amount of bleeding 1200m l. Perioperative death in 1 case, 3 cases of death within one year, one-year survival rate was 82.3%. Thirteen of 17 patients underwent retrograde resection. Conclusions [1] 1 case of perioperative death in this group, 3 cases of death within one year, one year survival rate of 82.3%, indicating that the removal of extra large liver tumors is safe and feasible. [2] 17 cases, 13 cases of retrograde resection, the method is easy to operate. [3] The reason why the liver mass can grow to such a huge, even if the liver cancer, but also most of the capsule, there is no early transfer, let alone benign or benign tumor malignant transformation, so the tumor is not a large contraindication for surgery, once removed Often also get a higher survival rate. Therefore, for large liver tumors, surgical treatment should hold a positive attitude.