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目的 强调肝癌术后及时、长期随访的重要性 ;探讨再手术治疗复发肝癌对延长生存期的价值。方法 对术后复发行再手术治疗的 44例肝癌作临床回顾总结 ,男 3 3例 ,女 11例 ,首次术后每 3个月复查AFP及B超或CT等检查 ;再切除 40例 ,单纯肝动脉、门静脉插管化疗及瘤内注射无水乙醇 ,电凝固化 4例 ;并与同期内复发的 46例肝癌未手术者作生存期对比。结果 术后 2年内复发者占 3 6.4% ( 16/44 ) ,为复发的高危险期 ;全组首次术后 1、3、5年生存率分别为 97.7%、60 .9%、5 5 .5 % ;再手术治疗后 1、3、5年生存率分别为 77.3 %、47.7%、43 .2 % ;同期 46例肝癌术后复发未再手术者平均生存期 6、7个月。结论 首次切除术后定时、长期随访是提高再切除率的关键。合理的选择再手术对象 ,积极地采取再切除治疗 ,是提高肝癌生存期的有效途径
Objective To emphasize the importance of timely and long-term follow-up of liver cancer surgery; to explore the value of reoperation for recurrence of liver cancer for prolonged survival. Methods Forty-four cases of liver cancer undergoing re-surgery after surgery were retrospectively reviewed. There were 33 males and 11 females. The AFP and B-ultrasonography or CT examinations were performed every 3 months for the first time; 40 cases were resected. Hepatic arterial and portal vein chemotherapy and intratumoral injection of absolute ethanol and electrocoagulation were performed in 4 patients. The survival period was compared with 46 patients who had recurrence in the same period. Results The incidence of recurrence within 3 years after operation was 36.4% (16/44), which was a high risk of recurrence. The first, third and fifth year postoperative survival rates were 97.7%, 60.9% and 55%, respectively. The survival rate at 1 year, 3 years and 5 years after reoperation was 77.3%, 47.7%, and 43.2%, respectively. During the same period, the average survival time of 46 patients who had reoperation after hepatectomy was 6 or 7 months. Conclusions The timing and long-term follow-up after the first resection is the key to improve the re-resection rate. Reasonable choice of re-operation targets and active re-excision treatment is an effective way to improve liver cancer survival time