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目的 :确定继发性肝癌的肝切除的适应症、方法、安全性和有效性。方法 :回顾分析 1992年 3月～ 1999年 5月的 6 7例继发性肝癌之肝切除 6 9次的随访资料 ,2 8 3%行左半肝切除 ,3%为右半肝切除 ,7 5 %为左外叶切除 ,13 4%为左内叶切除 ,2 3 9%为右前叶切除 ,19 4%为右后叶切除 ,1 5 %为部分肝叶切除或楔形切除 ,3%为微波刀切除 ;其中胰十二指肠切除并左半肝切除 3例 ( 4 5 % )。结果 :手术死亡 1例 ( 1 5 % )。余之随访 1～ 7年 (平均 5年 ) ,1、2、3、4、5年的生存率分别为 2 8 36 %、2 2 34 %、19 40 %、16 42 %和 11 94% ,其中大肠癌生存 >5年者 2 1 43%。结论 :此文和以前的文章证实了肝转移病的外科切除 ,不仅是安全的 ,而且在很多患者是有效的 ,并提供有意义的长期生存和切除后部分获得治愈。我们推荐 ,任何肝转移癌患者、解剖分布的肿瘤切除后肝功良好和能耐受手术者应考虑切除。
Objective : To determine the indications, methods, safety and efficacy of hepatectomy for secondary liver cancer. METHODS: We retrospectively analyzed the follow-up data of 67 liver hepatectomy cases from March 1992 to May 1999. Two-thirds of patients underwent left hemihepatectomy and 3% received right hemihepatectomy. 7 5% were left lobectomy, 13 4% left lobectomy, 23 9% right anterior lobectomy, 19 4% right lobectomy, 15 % partial lobectomy or wedge resection, 3% Microwave knife resection; pancreatic duodenal resection and left hemihepatectomy in 3 cases (45%). Results : 1 case (15 %) died after surgery. During follow-up of 1 to 7 years (mean 5 years), the survival rates at 1, 2, 3, 4 and 5 years were 2386%, 2244%, 1940%, 162% and 1194%, respectively. Of these, 21% of colorectal cancer patients survived >5 years. CONCLUSION: This article and previous articles confirm that surgical resection of liver metastases is not only safe, but also effective in many patients, and provides meaningful long-term survival and partial cure after resection. We recommend that any patients with liver metastases, anatomically distributed tumors with good liver function, and able to tolerate surgery should be considered for resection.