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

复发性肝癌诊治的几个焦点问题

汪珍光，周伟平   

  1. 海军军医大学东方肝胆外科医院肝外三科，上海 200438
  • 出版日期:2019-10-01 发布日期:2019-10-10

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

摘要：

复发性肝癌是临床治疗肝癌病人的常见问题。目前，缺乏针对复发性肝癌的分期方案和治疗体系，缺少高水平的临床研究，在治疗上有较多争议。复发性肝癌的治疗争议主要体现在是否需要积极采用手术再切除或肝移植等创伤大的治疗手段。针对多克隆起源的复发肿瘤，临床治疗决策基本参照初发肝癌的分期和治疗体系，预后不劣于初发肿瘤。而对于短期内出现的单克隆起源的复发肿瘤，临床治疗更趋于介入、消融、放疗或靶向药物等创伤小的治疗手段。制定肝癌治疗方案必须综合考虑治疗创伤、安全性、有效性和费用等多个因素，复发性肝癌的治疗既类似于初发肝癌，又不同于初发肝癌。因此，其治疗不能完全参考初发肝癌的治疗体系。

关键词: 复发性肝癌, 预后因素, 手术切除, 肝移植, 腹腔镜

Abstract:

Focus problems in diagnosis and treatment of recurrent hepatocellular carcinom        WANG Zhen-guang，ZHOU Wei-ping. The 3rd Department of Hepatic Surgery，Eastern Hepato-biliary Surgical Hospital，Naval Medical University，Shanghai 200438，China
Corresponding author：ZHOU Wei-ping，E-mail：ehphwp@126.com
Abstract    Recurrent hepatocellular carcinoma (HCC) is a common problem in the treatment of HCC patients. At present，there is a lack of staging and treatment system for recurrent hepatocellular carcinoma，and a lack of high-level clinical research. Therefore，there is much controversy in the treatment of recurrent hepatocellular carcinoma. The controversy is mainly focused on whether it is proper to take aggressively repeated surgical resection or liver transplantation. For recurrent tumors of polyclonal origin，clinical treatment decisions are basically based on the staging and treatment system of primary hepatocellular carcinoma，and the prognosis is not inferior to that of primary tumors. For recurrent tumors of monoclonal origin，it tends to be less invasive，such as interventional，ablation，radiotherapy or targeted drugs. The treatment strategy for hepatocellular carcinoma must consider many factors, such as trauma，safety，effectiveness and cost. It is similar to and still a little different from that of primary hepatocellular carcinoma. Therefore，the treatment of recurrent hepatocellular carcinoma cannot fully refer to the treatment system of primary hepatocellular carcinoma.

Key words: recurrent hepatocellular carcinoma, prognostic factor, surgical resection, liver transplantation, laparoscopy