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国内外指南与共识中肝癌手术切缘相关内容解读

戴朝六贾昌俊   

  1. 中国医科大学附属盛京医院肝胆脾外科,辽宁沈阳110004
  • 出版日期:2018-04-01 发布日期:2018-03-30

  • Online:2018-04-01 Published:2018-03-30

摘要:

手术切缘是影响肝癌术后复发的重要因素之一。阴性手术切缘(R0)可以降低肝癌术后复发率,但手术切缘的大小和术后复发及预后的关系研究结果尚不统一。在满足剩余肝体积足够的情况下,≥1 cm是多数情况下推荐的手术切缘标准。但肝癌的术后复发受多种因素影响,是手术彻底性和手术安全性之间的平衡问题。肝癌治疗效果的提高是一个系统工程,R0仅是其中的目标或问题之一。根据肿瘤的生物学和影像学特点,借助越来越先进的检查和治疗技术,个体化的多学科综合治疗仍将是降低肝癌术后复发、改善预后最为重要的手段或途径。

关键词: 肝细胞癌, 手术切缘, 指南

Abstract:

Interpretation of liver resection margin from the guidelines of China and abroad about liver cancer                      DAI Chao-liu,JIA Chang-jun. Department of Hepatobiliary and Splenic Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China
Corresponding author:DAI Chao-liu,E-mail:daicl@
sj-hospital.org
Abstract    The surgical resection margin is an important prognostic factor of postoperative recurrence and survival in hepatectomy for patients with hepatocellular carcinoma (HCC). Negative surgical resection margin (R0) can reduce the postoperative recurrence rate and improve the prognosis of patients with HCC. But the effect of resection margin width on recurrence-free survival and long-term survival is still controversial. Under the premise of sufficient future liver remnant,the width of resection margin ≥ 1 cm should be recommended in most conditions. But recurrence after primary resection is multifactorial,R0 resection is just one of the problems in the treatment of HCC. Optimization of individual multidisciplinary therapy is an important way to improve the overall efficacy of HCC.

Key words: hepatocellular carcinoma, resection margin, guideline