摘要
肝细胞肝癌（HCC）在香港是居于第二位的致死恶性肿瘤，肝切除手术是治疗HCC最为常用和有效的方法。香港大学玛丽医院在最近9年来，肝切除技术和围手术期管理已经逐渐形成了一套自己的常规。为了避免不必要的开腹手术，术前仔细地检查和估计肿瘤扩散的范围及病人的肝功能情况十分重要，超声刀和Pringle技术的采用能够有效地减少术中失血，术后管理和围手术期营养支持也是重要的确保肝切除术成功的因素。玛丽医院肝切除术后病人的住院死亡率从1989年的28％降至1996和1997年的0％，近4年来，术中中位输血量为0，有64％的病人不需接受输血治疗，近2年更是在连续110例病人中实现了零住院死亡率。多变量分析显示：术中失血量、输血量和手术时间与术后并发症的发生明显相关；而输血、TNM分期和术前ICG值是决定肿瘤复发的主要因素；失血量、术前ICG值和TNM分期是决定整体生存率的预发因素。为了尽可能延长HCC病人的生命，尽量减少术中失血、避免输血和缩短手术时间应是所有肝脏外科医生努力的方向。
Hepatocellular carcinoma (HCC) is the second commonest killing cancer in HongKong. Hepatectomy is the commonest and most effective curative treatments for HCC. Over the last 9 years,at Queen Mary Hospital of the University of HongKong,the surgical techniques and perioperative management in hepatectomy for HCC have evolved into a standardized protocol. To avoidunnecessary laparotomy,careful preoperative evaluation of the extent of the tumour spread and the liver function are important.Uitrasonic dissector and Pringle maneuver can reduce blood loss effectively during hepatectomy. The postoperative care and perioperative nutritional support are equally important to secure success in hepatectomy. The hospital mortality rate after hepatectomy decreased from 28% in 1989 to 0% in 1996 and 1997 at Queen Mary hospital. In the last 4 years,the median blood transfusion requirement was 0ml 1 and 64% of the patients did not require blood trans fusion in hepatectomy. During the last 2 years,hospital mortalityin 110 consecutive patients was zero. On multivariate analysis,the volume of blood loss,volume of blood transfusion and operationtime are correlated postitively with postoperative morbidities. Blood transfusion,TNM staging and preoperative ICG value are majorfactors in determining tumour recurrence while the volume of blood loss,preoperative ICG value and TNM staging are the predictive factors of overall survival. Avoidance of bleeding, blood trans fusion and reducing the duration of operation should be allsurgeons endeavour in offering the patients with HCC a reasonable degree of prolongation of life.
出处
《肝胆外科杂志》
1998年第5期264-267,共4页
Journal of Hepatobiliary Surgery
关键词
肝细胞肝癌
肝切除术
治疗
外科手术
Hepatocellular carcinoma (HCC) Hepatectomy Surgical treatment
