肝癌合并肝硬化肝切除范围的探讨

Investigation of extent of liver resection for liver cancer combined with liver cirrhosis

  • 摘要: 肝切除术是治疗肝癌的有效方法之一。多数肝癌病人合并不同程度的肝硬化。肝硬化是影响肝切除术后手术效果的重要不利因素,且随着肝硬化程度加重不利影响愈加显著。目前普遍认为,肝功能Child A级的肝硬化病人可耐受60%体积的肝切除。然而,临床实践中外科医师常以有或无描述肝硬化,忽视了肝硬化程度对肝切除术疗效和安全性的影响。如何根据肝硬化程度确定科学合理的肝切除范围目前尚无一致结论。因此,笔者总结提出了肝切除术前及术中评估肝硬化程度的方法。笔者认为:随着肝硬化程度加重应适当缩小肝切除范围;术前如何更精确评估病人肝硬化严重程度、科学确定肝切除范围,仍需要更深入的研究结果证实。

     

    Abstract: Liver resection is widely accepted as firstline treatment for patient with liver cancer. Most patients with liver cancer have varied degrees of liver cirrhosis, which is an important risk factor adversely affect the outcomes of liver resection. The adverse effects are more significant as the increase of degree of liver cirrhosis. At present, it is generally believed that liver resection of 60% volume is appropriate for patients with liver cirrhosis when liver function is within Child A. However, surgeons usually assess whether a patient has liver cirrhosis using “Yes” or “No”, ignoring the pathological severity of liver cirrhosis. How to determine the extent of liver resection for patients combined with liver cirrhosis is still controversial. The authors have proposed a method for evaluating the degree of cirrhosis before and during surgery. It is believed that the extent of liver resection should be appropriately reduced with the increase of degree of liver cirrhosis. Further studies are needed to investigate how to accurately assess the severity of liver cirrhosis and how to scientifically determine the extent of liver resection before operation.

     

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