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目的探讨原发性肝癌癌周肝组织内微转移的分布情况,以确定肝癌切除所需要的切缘最小值。方法回顾性分析本组114例无肉眼癌栓或子灶的肝癌病人120次手术标本常规病理切片629张,前瞻性研究本组连续76例术前影像学检查未发现癌栓或子灶的肝癌手术标本及石蜡切片645张。肉眼观察肿瘤距切缘的大小、有无子灶或癌栓,镜下观察有无包膜、有无微卫星灶或微癌栓并测量其远端距肿瘤边缘的距离。采用SPSS10·0和SAS6·12统计软件包分析。结果回顾组120例次肝癌病人中:26例次(21·7%)瘤外肝组织内发现微转移灶;在95%、99%和100%的病例中微转移灶分别在距原发瘤边缘或包膜外3·9mm、5·9mm和6·7mm以内。前瞻组76例肝癌病人:无肉眼癌栓或子灶的59例病人中25例(42·1%)发现瘤外肝组织内微转移灶,在95%、99%和100%的病例中微转移灶分别在距原发瘤边缘或包膜外4·5mm、5·5mm和6·0mm以内;而术前影像学检查未发现而术中探查发现有肉眼癌栓或子灶的18例病人中14例(77·8%)发现瘤外肝组织内微转移灶,在95%、99%和100%的病例中微转移灶分别在距原发瘤边缘或包膜外18·5mm、18·5mm和19·0mm以内。结论对无肉眼癌栓或子灶、无肝外转移的肝癌切除99%和100%的微转移灶所需最小切缘分别为5·5mm和6mm;而对有肉眼癌栓或子灶的肝癌切除99%的微转移灶所需最小切缘应>18·5mm。
Objective To investigate the distribution of micrometastases in the peri-hepatic tissue of primary liver cancer in order to determine the minimum required margin for hepatectomy. Methods A retrospective analysis of 114 cases of non-cancerous liver cancer patients with non-cancerous or hepatic lesions in 120 surgical specimens routine pathological sections of 629, prospective study of 76 consecutive cases of preoperative imaging examination found no tumor plug or foci of liver cancer 645 surgical specimens and paraffin sections. Macroscopic observation of the tumor from the edge of the size, with or without sub-tumor or tumor thrombus, microscopic observation with or without capsule, with or without microsatellite tumor micro-tumor thrombus and measuring the distance from the distal edge of the tumor. Using SPSS10 · 0 and SAS6 · 12 statistical package analysis. Results In the retrospective group of 120 patients with HCC, micrometastases were found in 26 cases (21.7%) of the extrahepatic liver tissues. In 95%, 99% and 100% of the cases, Edge or capsule outside 3.9mm, 5.9mm and 6.7mm. Among 76 patients with liver cancer in the prospective group, 25 (42.1%) of the 59 patients without macroscopic embolus or foci were found to have micrometastasis in the extrahepatic liver tissue, and the micrometastases were found in 95%, 99% and 100% of cases Metastatic lesions were 4. 5mm, 5mm and 6.0mm apart from the edge of the primary tumor or capsule respectively. However, preoperative imaging examination was not found and 18 patients with intraocular tumor thrombus or foci Among the 14 cases (77.8%), micrometastases were found in extrahepatic liver tissue. Micrometastases in 95%, 99% and 100% of the cases were located at the margin of 18.5 mm · 5mm and 19 · 0mm or less. Conclusions The minimal margins required for 99% and 100% micrometastases in non-malignant tumor or metastatic non-extrahepatic liver cancer are 5.5 mm and 6 mm, respectively The minimum cut required to remove 99% of micrometastases should be> 18.5 mm.