F. Rayya, J. Harms, M. Bartels, D. Uhlmann, J. Hauss, J. Fangmann

  肝细胞癌（HCC）是目前常见的癌症之一。根据患者肿瘤的大小和肝硬化的发展现状，可以选择采用肝切除（LR）和原位肝移植（OLT）来进行治疗。肝硬化是导致切除术后早期患者发病率较高的主要原因。即使是处于Child A阶段，我们仍然不推荐对患者采用广泛切除的方法进行治疗。

  本研究讨论了肝硬化和非肝硬化患者采用手术（LR或OLT）治疗肝癌的疗效。我们分析了2001年1月至2006年12月期间进行LR或OLT手术的76名肝癌患者。

   非肝硬化的患者进行了以下几种切除手术：30例右半肝和大部右半肝切除（54.5%）；11例左半肝切除（20%）；14例一区或二区切除（25.5%）。肝硬化的患者进行了以下几种切除手术：Child A阶段的患者中1例右半肝切除，1例大部右半肝切除，1例大部左半肝切除，4例一区或二区切除；Child B阶段的患者3例一区或二区切除。在11例进行肝移植的患者中，2例患者的肿瘤超出了米兰标准。LR组中有5名患者在移植前接受经导管肝动脉化疗栓塞化疗。对肝硬化的肝癌患者应该慎重采用LR手术，目前我们还没有这些患者长期存活的数据。本研究证实OLT在治疗早期肝癌患者方面有着良好的长期生存率。但是，对于超出米兰标准的患者也许同样适用。对于非肝硬化的肝癌患者来说，仍然应该选择广泛使用的LR治疗方案，因为这种治疗能够获得良好的长期存活率。

Results of Resection and Transplantation for Hepatocellular Carcinoma in Cirrhosis and Noncirrhosis
F. Rayya, J. Harms, M. Bartels, D. Uhlmann, J. Hauss, J. Fangmann

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Both liver resection (LR) and orthotopic liver transplantation (OLT) are surgical treatment options depending on the size of the tumor and the presence of cirrhosis. Liver cirrhosis is the main reason for the high early postoperative mortality after resection. Even in the Child A stage, extensive resections are not recommended.
This study presented the results of surgical treatment (LR or OLT) for HCC in cirrhotic and noncirrhotic livers. We analyzed the data of 76 patients who underwent LR or OLT for HCC from January 2001 to December 2006.

In noncirrhotic livers the following resections were performed: 30 right and extended right hemihepatectomies (54.5%); 11 left hemihepatectomies (20%); and 14 mono- or bisegmentectomies (25.5%). In cirrhotic livers the following procedures were performed: in Child A stage 1 right hemihepatectomy, 1 extended right hemihepatectomy, 1 extended left hemihepatectomy, and 4 mono- or bisegmentectomies; and in Child B stage, 3 mono- or bisegmentectomies.

Among 11 patients who underwent transplantation, tumors in 2 patients exceeded the Milan criteria. Five patients in the LR group were treated with transarterial chemoembolization before transplantation. LR for HCC in cirrhosis should be performed with caution; there were no long-term survivors in our data. Our study confirmed that OLT shows good long-term survival in early HCC stages. However, this may also be true for stages above the Milan criteria. For HCC in noncirrhotic livers, LR remains the treatment of choice, justifying an extensive surgical approach. Such an approach achieved favorable long term survivals.

Volume 40, Issue 4, Pages 933-935 (May 2008)

[责任编辑:刘 聪]