首页|肝细胞癌肝切除术后腹腔转移再次手术切除19例分析

肝细胞癌肝切除术后腹腔转移再次手术切除19例分析

Analysis of 19 cases of resection of abdominal metastases after liver resection for hepatocellular carci-noma

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目的 探讨肝细胞癌肝切除术后腹腔转移再次手术的临床价值.方法 回顾分析2010年1月至2022年1月宁波市医疗中心李惠利医院肝胆胰外科行手术切除的2 748例肝癌患者资料.最后纳入19例肝切除术后腹腔转移再次手术切除患者,均为男性,年龄27~68岁,中位数53岁.记录腹腔转移灶诊断和手术术式,随访患者的复发和生存情况.结果 19例肝细胞癌患者手术后复查,10例患者经增强CT诊断为肝癌术后腹腔转移,7例患者经MRI诊断;2例患者经MRI及PET/CT检查均未发现腹腔转移,其中1例因肝癌术后复发再手术中发现腹腔转移,另1例因肝癌术后复发行肝移植术中发现腹腔转移.19例患者均顺利完成腹腔转移灶的根治性切除,18例开腹手术,1例腹腔镜手术,其中单纯转移灶切除9例,联合肝癌切除6例,联合肝癌及右半结肠切除1例,联合直肠部分切除1例,联合小肠部分切除1例,联合同种异体肝移植1例.19例患者术后1、3、5年无瘤生存率分别为26.3%、15.8%、10.5%,1、3、5年累积生存率分别为94.7%、26.3%、15.8%.目前无瘤存活3例,总生存期分别为154.3、67.3、33.4个月,均为腹腔内单发转移灶,且术后未接受任何靶向、免疫等药物治疗.结论 对于肝细胞癌术后腹腔内较局限或单发转移灶患者,再次行根治性手术切除能带来生存获益.
Objective To evaluate the reoperation of abdominal metastasis after liver resection for hepatocellular carcinoma(HCC).Methods The data of 2748 patients with liver cancer undergoing surgi-cal resection at the Department of Hepatobiliary and Pancreatic Surgery of Li Huili Hospital of Ningbo Medi-cal Center from January 2010 to January 2022 were retrospectively screened.A total of 19 patients with abdominal metastases after liver resection undergoing reoperation were enrolled,which were all males with a median age of 53 years(27 to 68).The surgical procedures and diagnosis for abdominal metastases were recorded,and the recurrence and survival of patients were followed up.Results During the follow-ups of initial resection of HCC,10 patients were diagnosed with postoperative abdominal metastasis by enhanced CT,and seven patients were diagnosed by MRI.MRI and PET/CT were negative in two patients.Abdominal metastasis was found during reoperation in one case and liver transplantation in the other case due to postop-erative liver recurrence.All 19 patients successfully underwent radical resection of abdominal metastases.Eighteen patients underwent open surgery and one underwent laparoscopic surgery.Among them,nine cases underwent simple metastases resection,six combined liver resection,one combined liver resection and right hemicolectomy,one combined partial rectal resection,one combined partial small bowel resection,and one combined liver transplantation.The 1-year,3-year,and 5-year disease-free survival rates were 26.3%,15.8%,10.5%,respectively.The 1-year,3-year,and 5-year overall survival rates were 94.7%,26.3%,15.8%,respectively.Three patients are currently surviving disease-free for 154.3 months,67.3 months,and 33.4 months,respectively.These three patients all had single abdominal metastase and did not receive any targeted or immune treatments after surgery.Conclusion For patients with localized or single abdomi-nal metastases after HCC surgery,reoperation for metastases can bring survival benefits.

Carcinoma,hepatocellularPrognosisAbdominal metastases

朱宏达、陆才德、杨勇、房炯泽

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宁波市医疗中心李惠利医院肝胆胰外科,宁波 315041

癌,肝细胞 预后 腹腔转移灶

2024

中华肝胆外科杂志
中华医学会

中华肝胆外科杂志

CSTPCD北大核心
影响因子:1.846
ISSN:1007-8118
年,卷(期):2024.30(3)
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