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目的 探讨复发性肝癌发现的途径 ,再切除的路径和手术方法 ,再切除的疗效以及影响再切除肝癌预后的因素。方法 研究 5 7例肝癌术后复发的各种发现途径 ,5 7例复发性肝癌进行再切除 ,比较第一次术后的无瘤生存期、再切除术后的生存期、累积生存期以及影响预后的相关因素。结果 复发性肝癌的诊断手段为术后AFP再次升高 36例 (81.8% ) ,CT发现病灶 43例 (87.7% ) ,B超发现病灶 33例 (6 4.7% )。第一次手术后的 1,3,5 ,10年无瘤生存率分别为 6 3.9% ,38.3 % ,2 6 .6 % ,12 .8% ;再切除后的 1,3,5 ,10年生存率为 5 6 .6 % ,37.7% ,31.9% ,16 .2 % ;而 1,3,5和 10年的累积生存率分别为 82 .1% ,6 0 .8% ,47.6 % ,19.5 %。影响再切除预后的因素有肿瘤的大小、数目、复发时间、再手术切除根治与否。结论 肝癌术后AFP的监测和定期的CT检查是发现复发性肝癌的最佳途径。再切除是治疗复发性肝癌的有效方法之一。肿瘤的大小、数目、复发时间、是否有完整包膜和再手术方式都是影响复发性肝癌手术预后的因素
Objective To explore the pathogenesis of recurrent hepatocellular carcinoma, the path and surgical method of re-excision, the efficacy of re-excision, and the factors affecting the prognosis of re-excision of liver cancer. Methods A total of 57 cases of postoperative recurrences of hepatocellular carcinoma were studied, and 57 recurrent hepatocellular carcinomas were re-excised. The tumor-free survival of the first postoperative period, the survival period after re-excision, the cumulative survival period, and the effect were compared. Prognostic factors. Results The diagnosis of recurrent hepatocellular carcinoma was as follows: postoperative AFP increased again in 36 cases (81.8%), CT found lesions in 43 cases (87.7%), and B-ultrasound found lesions in 33 cases (6.7%). The disease-free survival rates at 1, 3, 5, and 10 years after the first operation were 6 3.9%, 38.3%, 26.6%, 12.8%, respectively; 1, 3, 5, and 10 years after re-excision. The survival rates were 56.6%, 37.7%, 31.9%, and 16.2%, while the cumulative survival rates at 1, 3, 5, and 10 years were 82.1%, 60.8%, 47.6%, and 19.5, respectively. %. Factors affecting the prognosis of re-resection include tumor size, number, recurrence time, and re-surgical eradication. Conclusion The monitoring of AFP after liver cancer surgery and regular CT examination is the best way to find recurrent liver cancer. Re-excision is one of the effective methods to treat recurrent liver cancer. The size, number, time of recurrence, complete capsule and reoperation are the factors affecting the prognosis of recurrent hepatocellular carcinoma.