中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

肝癌术后复发再次手术的价值及合理选择

梁力建   

  1. 中山大学附属第一医院肝外科、胆胰外科，广东广州 510080
  • 出版日期:2019-10-01 发布日期:2019-10-10

  • Online:2019-10-01 Published:2019-10-10

摘要：

对于复发性肝癌，肝切除手术是积极、主动的治疗方法，选择合适的病例可获得良好的效果。复发性肝癌符合Milan标准，美国东部肿瘤协作组（ECOG）评分为0~2分，可考虑行挽救性肝移植（SLT）。如肿瘤直径<5 cm，单个或多个集中在一定范围、位于肝边缘、肝功能尚好的应首选再次肝切除治疗。在设备良好、有经验积累的单位，也可考虑行腹腔镜手术。对于肿瘤直径>5 cm的复发性肝癌，只要肝脏储备功能允许、剩余肝体积（FRLV）足够，应积极争取再次切除。如果已经证实复发性肝癌为单中心起源或合并微血管侵犯（MVI），建议进行综合治疗，除再次肝切除外，应序贯联合应用射频消融（RFA）、经导管动脉化疗栓塞（TACE）、TACE+RFA、靶向药物等，否则单纯再次肝切除疗效并不理想。如果复发性肝癌合并肝功能失代偿、严重肝硬化、门静脉高压症、肝内脉管主干受侵犯，建议放弃再手术切除而采用其他的非手术治疗方法。

关键词: 复发性肝癌, 肝切除术, 挽救性肝移植, 射频消融

Abstract:

Value and reasonable choice of reoperation for recurrence of hepatocellular carcinoma after operation             LIANG Li-jian. Department of Hepatobiliarypancreatic Surgery，the First Affiliated Hospital of Sun Yat-sen University，Guangzhou 510080，China
Abstract    For recurrent hepatocellular carcinoma（HCC），hepatectomy is an active and active treatment method. Choosing appropriate cases will get good results. Recurrent HCC complies with Milan criteria，ECOG score is 0-2，and salvage liver transplantation (SLT) can be considered. If the diameter of the tumor is less than 5 cm，single or multiple lesions are concentrated in a certain area，located at the edge of the liver，and the liver function is good，hepatectomy should be the first choice. Laparoscopic surgery may also be considered in units with good equipment and accumulated experience. For recurrent HCC with tumor diameter > 5 cm，as long as liver reserve function is allowed and FRLV is sufficient，it should be actively strived for resection again. If it has been proved that recurrent HCC originated from a single center or combined with MVI，comprehensive treatment should be rationally arranged. Besides hepatectomy，RFA，TACE，TACE+RFA and targeted drugs should be sequentially combined. Otherwise，the effect of hepatectomy alone is not ideal. If recurrent HCC is accompanied by decompensation of liver function，severe cirrhosis，portal hypertension，and invasion of the main intrahepatic vascular trunk，it is recommended to abandon reoperation and adopt other non-surgical treatment.

Key words: recurrent hepatocellular carcinoma, hepatectomy, salvage liver transplantation, radiofrequency ablation