中国实用外科杂志

中国实用外科杂志

• 普通外科进展 • 上一篇    下一篇

合并大血管侵犯肝细胞癌外科治疗的争议与共识

陈亚进，曹    君   

  1. 中山大学孙逸仙纪念医院肝胆外科，广东广州510120
  • 出版日期:2018-02-01 发布日期:2018-02-24

  • Online:2018-02-01 Published:2018-02-24

摘要：

合并大血管侵犯肝细胞癌的外科治疗，目前存在技术难度、并发症发生率和病死率较高与肿瘤学疗效获益之间的矛盾。现有的国内外指南共识存在分歧，分型方法也有差异。虽然越来越多的研究结果显示以外科手术为主的综合治疗或许能为病人带来可重复性的获益，但仍存在争议。越来越多的学者支持对肝功能Child-Pugh A级、肝脏肿瘤可切除、分型较好的合并门静脉癌栓（PVTT）、肝静脉癌栓（HVTT）或下腔静脉癌栓（IVCTT）的病人实施手术切除，并得到了可重复性的获益。但对于侵犯门静脉主干的PVTT，以及侵犯心房的IVCTT实施手术切除，大部分学者仍持谨慎态度。大样本随机对照研究将为该领域带来更高级别的循证医学证据，最终促进指南共识的修订和更新。

关键词: 肝细胞癌, 血管侵犯

Abstract:

Surgical treatment of hepatocellular carcinoma with large vascular invasion：controversy and consensus                     CHEN Ya-jin, CAO Jun.Department of Hepatobiliary Surgery, Sun Yat - sen Memorial Hospital, Sun Yat - sen University，Guangzhou 510120，China
Corresponding author：CHEN Ya-jin，E-mail：cyj0509@126.com
Abstract    Surgical intervention for hepatocellular carcinoma associated with macroscopic vascular invasion is regarded as a challenging work with high rate of complications and death, and the oncological benefit is not entirely clear. There are differences between domestic and overseas staging system and treatment guidelines. Although increasing studies have shown the surgical intervention and adjunct multi modality treatment are feasible and the results are reproducible, some controversies remain. More and more scholars support surgical resection for patients with liver function Child-Pugh class A, liver tumor resectable, and well typed PVTT, HVTT or IVCTT, and get reproducible benefits. However, most scholars remain cautious about the surgical resection of the PVTT with major portal vein invasion and IVCTT with  the atrium invasion. Large-sample and high-quality RCTs are needed to confirm the reliability of these studies, and ultimately promote the update of guidelines.

Key words: hepatocellular carcinoma, vascular invasion