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目的 原发性肝癌手术切除后 ,复发是大多数患者术后的死亡原因。本文旨在评价原发性肝癌术后复发和肝外转移灶再切除的疗效并总结经验。方法 对 196 0年 1月到 2 0 0 0年 7月的 2 6 7例再切除的复发性肝癌患者的临床资料进行回顾性分析 ,其中 2 0 5例行再次肝切除 ,5 1例行肝外转移癌切除 ,11例行复发性肝癌和肝外转移癌联合切除 ,并进行临床病理特征和手术类型和生存率的比较。结果 再次肝切除中 ,11.2 %患者行左外叶切除术 ,4.4%行半肝切除术或扩大半肝切除术 ,6 8.3 %行局部根治性切除 ,17.1%行亚段切除术。复发高峰 ( 6 4.4% )在 1～ 2年。二次手术后总的 1,3,5和 10年生存率为 81.0 % ,40 .3% ,19.4%和 9.0 % ,而三次手术后则为 77.5 % ,2 9 .8% ,13 .2 %和 6 .6 1%。中位生存时间为 44个月。肝外转移癌的再切除也延长了生存期。结论 结果表明局部根治性切除和亚段切除适用于大多数再次肝切除。复发高峰可能与门静脉癌栓及手术因素相关。再手术切除不但适用于肝内复发癌也适用于肝外转移癌。鉴于目前化疗或非手术治疗均不能达到比再切除更满意的效果 ,因此 ,再切除是复发性肝癌的首选治疗方法。
Objective After primary liver cancer resection, the recurrence is the cause of postoperative death in most patients. This article aims to evaluate the efficacy of recurrent and extrahepatic metastases in patients with primary liver cancer and to summarize the experience. Methods A retrospective analysis was performed on the clinical data of 267 recurrent HCC patients between January 196 and July 2000, of which 205 cases underwent re-hepatectomy and 51 cases received liver resection 11 cases of recurrent and extrahepatic metastases were resected, and the clinicopathological characteristics, operation type and survival rate were compared. Results In the re-hepatectomy, 11.2% of the patients underwent left-sided resection, 4.4% underwent semi-hepatectomy or extended hemi-hepatectomy, 6.33% underwent radical radical resection and 17.1% underwent subtotal resection. Recurrence peak (6 4.4%) in 1 to 2 years. The overall 1, 3, 5, and 10-year survival rates after secondary surgery were 81.0%, 40.3%, 19.4%, and 9.0%, compared with 77.5%, 29.8%, 13.2% And 6.16%. The median survival time was 44 months. Resection of extrahepatic metastases also prolongs survival. Conclusions The results show that local radical resection and subtotal resection are suitable for most resections. Recurrence peak may be related to portal vein tumor thrombus and surgical factors. Re-surgical resection is not only applicable to intrahepatic recurrent carcinoma but also to extrahepatic metastatic carcinoma. In view of the current chemotherapy or non-surgical treatment can not reach more than resectable more satisfactory results, therefore, resection is the treatment of choice for recurrent liver cancer.