中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (01): 36-38.

• 普通外科进展 • 上一篇    下一篇

小肝癌的规范化治疗路径

樊    嘉,史颖弘,高    强   

  1. 复旦大学附属中山医院,上海200032
  • 出版日期:2011-01-01 发布日期:2011-05-30

  • Online:2011-01-01 Published:2011-05-30

摘要:

当前,手术切除仍是小肝癌治疗的首选,是获得长期生存的重要途径。射频和微波消融等技术的进步,小肝癌治疗由单一手术治疗过渡到手术与非手术治疗并存。消融治疗和手术切除者的存活率无显著差异,但手术切除无瘤生存及复发率则更具优势。肝移植不仅去除肿瘤,同时也解决了小肝癌多中心起源的问题,与肝切除相比,小肝癌肝移植后存活率稍高,复发率稍低。尽管如此,小肝癌的转移复发率仍居高不下,癌细胞本身、肿瘤微环境和肝病背景均发挥着不容忽视的作用。因此,肝癌的早期发现和早期诊断、遵循基于循证医学的规范化治疗路径,以及肿瘤生物学基础研究的临床转化,是实现小肝癌疗效再次飞跃的保证。

关键词: 肝细胞肝癌, 手术切除, 肝移植, 消融治疗, 转化医学

Abstract:

Medical approach to treatments of small liver cancer        FAN Jia, SHI Ying-hong, GAO Qiang. Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author:FAN Jia, E-mail: jiafan99@yahoo.com
Abstract    Currently, surgical resection remains the prior treatment choice for small hepatocellular carcinoma (HCC), and long term survival is predictable in those received hepatectomy. The advent and technical progression in radiofrequency and microwave ablation provide alternative choices for small HCC. Although local ablative therapies have yield similar overall survival rates to that of surgical resection, surgical resection is superior to local ablative therapies in terms of recurrence rate and tumor-free survival. Liver transplantation simultaneously removes HCC and the underlying diseased liver, and thus eliminates the possibility of multicentric tumor occurrences. Consequently, liver transplantation for small HCC has a slightly higher survival rate and a relatively low recurrence rate, as compared with surgical resection. Nonetheless, the high post-treatment recurrence/metastasis rate of small HCC remains unchanged, in which the characteristics of HCC cells, tumor microenvironment and the underlying hepatitis collectively contribute. In future clinical practice, we must bear in mind that only early diagnosis, evidence based treatment modalities and translation from bench to bedside were properly administrated, could additional breakthroughs in small HCC can be achieved.

Key words: hepatocellular carcinoma, surgical resection, liver transplantation;ablative therapies, translational research.