Long‐term survivors after resection for primary liver cancer. Clinical analysis of 19 patients surviving more than ten years
Long‐term survivors after resection for primary liver cancer. Clinical analysis of 19 patients surviving more than ten years
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原发性肝癌切除后19例存活10年以上患者的临床分析
DOI：
10.1002/1097-0142(19890601)63:11
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发表时间：
1989
期刊：
影响因子：
6.2
通讯作者：
Chen‐Long Tang
中科院分区：
文献类型：
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作者：
Xin;Z. Tang;Yeqin Yu;Bing;Zhi;Ji‐Zhen Lu;Zeng;Chen‐Long Tang
1958年7月至1978年6月，中华人民共和国上海医科大学附属中山医院收治了经病理证实的原发性肝癌（PLC） 333例。其中，39.6%（333人中有132人）被切除，14.4%（132人中有19人）在切除后存活超过10年。本文对19例存活10年以上的患者进行了调查。19例患者均行根治性切除，其中右半肝切除2例，左半肝切除10例，左外侧节段切除3例，局部切除4例。到1988年6月底，随访时间从10年1个月到26年7个月不等，平均随访时间为15年4个月。所有19名患者仍然活着，没有疾病。存活时间最长的患者肿瘤大小为10 × 8 × 6 cm，行局部切除。经过26年零7个月的随访，发现患者仍然生活良好。2例腹膜内PLC破裂患者在切除肿瘤后，分别存活了19年4个月和16年11个月，并已恢复工作。1例患者再次行冷冻手术，发现PLC亚临床复发。患者在冷冻手术后8年零10个月的时间里，甲胎蛋白（AFP）呈阴性，情况良好。由于AFP水平的继发性升高，在两例患者中检测到亚临床孤立性肺转移。再次手术切除转移性肿瘤。两例患者再次手术后分别为9年6个月和10年1个月，均为AFP阴性，健康状况良好。这些结果表明，早期和根治性切除是影响长期生存的主要因素；亚临床复发和单发转移的再手术仍是进一步延长生存期的重要途径；PLC腹腔破裂不排除治愈的可能性；新的手术技术，如冷冻手术和无血肝切除术，已被证明对一些患者有效。
From July 1958 to June 1978, a total of 333 cases with pathologically proven primary liver cancer (PLC) were admitted to the Zhong Shan Hospital, Shanghai Medical University, Shanghai, the people' Republic of China. Of these, 39.6% (132 of 333) were resected and 14.4% (19 of 132) survived over 10 years after resection for PLC. These 19 patients surviving over 10 years were investigated in this paper. All 19 patients underwent radical resection, including right hemihepatectomy in two cases, left hemihepatectomy in ten cases, left lateral segmentectomy in three cases, and local resection in four cases. By the end of June 1988, follow‐up varied from 10 years and 1 month to 26 years and 7 months, with a mean followup of 15 years and 4 months. All 19 patients are still alive with free of disease. The longest survival patient had a tumor measuring 10 × 8 × 6 cm in size and underwent local resection. Upon follow‐up after 26 years and 7 months, the patient was found to be still living and well. Two patients with intraperitoneal ruptured PLC have survived for 19 years and 4 months, and 16 years and 11 months, respectively, after resection of the tumors free of disease and have returned to work. Subclinical recurrence of PLC was discovered in one patient in whom reoperation with cryosurgery was carried out. The patient has been in good condition with negative alpha‐fetoprotein (AFP) for 8 years and 10 months after cryosurgery. Subclinical solitary pulmonary metastasis was detected in two patients because of a secondary rise in AFP level. Reoperations were carried out and the metastatic tumors were removed. These two patients are still in good health with negative AFP 9 years and 6 months, and 10 years and 1 months, respectively, after reoperation. These results indicate that early and radical resection are the principal factors influencing long‐term survival; reoperation for subclinical recurrence and solitary metastasis remains an important approach to prolong survival further; intraperitoneal rupture of PLC does not exclude the possibility of cure; new surgical techniques, such as cryosurgery and bloodless hepatectomy, have been shown to be effective in some patients.
Kyuzo Yamashita；Nakazo Watari：东方医学和疼痛诊所 17(2) (1987)。
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