A stage surgery of hepatocarcinoma treats _'s treatment

A stage surgery of hepatocarcinoma treats _'s treatment
Surgical treatment of a stage hepatocarcinoma

Number 3 of Vol. 22 of 2000 of Chinese tumour magazine

Wang ChengFeng Shao YongFu Blue loyal member of a nationality

SummaryPurposeCanvass the result to a stage hepatocarcinoma of surgical treatment.MethodPerson who review analyze 27 the intersection of a stage and the intersection of hepatocarcinoma and patient among the 1989- 1998 year, surgery excise 19 (excise group) among them ,Reduce the intersection of tumour and skill, add absolute alcohol inject 8 in the skill ' Reduce the tumour skill group) . Competent Ultrasonography B check, omit the focus, try hard, excise all the intersection of tumour and tubercle in the skill, remain tubercle and implement Ultrasonography B and lead absolute alcohol under to inject the skill. Will reduce the tumour skill and locate many method preface to pass through while treating.ResultAll 27 patients' 1, 2, survival rate is 71.4%, 55.6% and 7.7% respectively in 3. Excise the group and reduce group 1, 2 of the tumour skill, survival rate is 73.3%, 58.3%, 10.0% and 66.7%, 50.0%, 0 (P> 0.05) respectively in 3 . The postoperative complication incidence is 22.0%, there is no operation death and die in hospital.Conclusion A stage hepatocarcinoma implement surgical treatment, include, excise skill, reduce the intersection of tumour and skill, add other aid, it treats to be first-selected effective method.

KeyWord:Liver tumour surgery; The liver excises the skill; Survival rate

Primary hepatocarcinoma ' Hereafter referred to as hepatocarcinoma) It is disease jeopardizing human health seriously, surgery is its main treatment means. Though liver surgery in diagnostic method, scientific and technological skill outside, enclose person who punish make obvious progress already by respect period such as operation, but a stage hepatocarcinoma is still treatment for not performing the operation as the main fact, the result is extremely bad (life cycle is only 8 weeks in the location of China) . In recent years, the foreign scholar tries the surgery treatment to a stage hepatocarcinoma, the result is encouraging. The intersection of surgery and therapeutic 27 the intersection of a stage and the intersection of hepatocarcinoma and the intersection of situation and as follows report of patient under 1989- 1998 year such as our academy now.

Material and method

1.Clinical materials: 24 the men of this group, 3 women. 35-72 years old, 53.9 average years olds. The course of disease was from 11 days to 3, average 3.9 months. The person who has medical history of liver accounts for 48.1% (13/27) ,Medical history 10 year 4. The smoking history accounts for 63.0% (17/27) ,The history of drinking accounts for 44.4% (12/27) .

2.Check and grade with liver function in the laboratory: Leucocyte9/8 of L person, blood platelet9/L person is 7. Unusual 21 of liver function, total bilirubin> is 5 of 17.1 mol/L person among them, one is dominant jaundice, the time of thrombinogen lengthens 16. The number of hepatitis index is positive 22. 18 of 25 g/L person for first child globulin>, persons who are among them is greater than or equal to 400 g/L are only 7. Pugh liver function is graded: A grade accounts for 44.4% (12/27) ,B grade accounts for 55.6% (15/27) .

3.Treat before the skill: Artery thromboembolism chemotherapy of liver (TACE) 5, 1- 2 times. Put and in charge of 1 case of chemotherapy by the portal vein.

4.Operation situation: The intersection of patient and the intersection of cancer and the intersection of tubercle and the intersection of number and 2- 6, occupy both sides half liver person, account for 48.1% (13/27) ,One side half liver person account for 51.9% (14/27) . It is 0.5- 11 cm that cancer and tubercle are big or small. Person who can excise all visiting and tubercle of operation (excise the group) 19, accounts for 70.4%; Cancer the intersection of tubercle and majority excise, add Ultrasonography B lead down residual absolute alcohol of tumour tubercle injector (reduce the tumour skill group) in the skill 8, accounts for 29.6%. The time of operation is 1.2- 4.8 h, average 2.6 h. Blood transfusion 0- 2 800 ml, average 681.5 ml in the skill.

5.Postoperative pathology: Cellulous hepatocarcinoma of the liver accounts for 96.3% (26/27) ,High, middle and low among them to split up as 30.8%, 50.0% and 19.2% respectively; Mixing hepatocarcinoma accounts for 3.7% (1/27) .

6.Postoperative treatment: 15 of TACE, 1- 8 times. Melt, treat 1 all over, treat traditional Chinese medicine, immunization therapy,etc. while being other.

Result

Excise the group and reduce group 1, 2 of the tumour skill, survival rate is 73.3% (11/15) respectively in 3 , 58.3% (7/12) , 10.0% (1/10) With 66.7% (4/6) , 50.0% (3/6) , 0 (P> 0.05) . The whole group 1, 2, survival rate is 71.4% (15/21) respectively in 3 , 55.6% (10/18) With 7.7% (1/13) .

The postoperative complication incidence is 22.0%, including wound split open and wound accumulate liquid, digestive tract bleed, lower extremities intravenous thrombus, getting obstinate the intersection of chest and water need, turn on the intersection of chest and operation and bleed, need, excise all 1 of spleen under the the intersection of spleen and capsule, there is no operation death and die in hospital.

Discussion

By stages according to TNM of UICC, a stage the hepatocarcinoma, in order to exceed many focuses of a lobe of the liver or infringe the portal vein or intravenous main branch of liver, but there is not hepatocarcinoma shifted outside liver (T4N0- 1MO). The traditional idea thinks, a pathological change that a stage hepatocarcinoma develops, it is operation taboo disease. Through adopting surgery to treat to a stage hepatocarcinoma and further understanding of a stage hepatocarcinoma, numerous scholars think, the rare curative effect of other methods up till now, except that the liver has been excised[1,2]. The image learns to check and excise the focus for the single shot before the skill of 27 patients of this group, but find that for a stage hepatocarcinoma, but examine for the chance that the patient of hepatocarcinoma had not won surgery treatment of a stage before most skills while ascertaining in the skill.

Reducing the tumour skill belongs to the condoning operation, can reduce tumour cell and tumour load to the greatest extent, strengthen residual tumour cells to the sensitiveness of melting, radiotherapy, namely pass the proportion which increases proliferative cells, reduce the quantity of eliminating tumour cells in chemotherapy cycle, change the distribution of tumour and inner oxygen and nutriment, reduce the hyperplasia able to bear medicine cells. The ones that should be emphasized should try hard to excise tumour in an operation. Yamamoto,etc.[3]Report that contains, more grows slow cells and forms a cluster in a stage tumour and tubercle of hepatocarcinoma, and the intersection of method and preface pass through complex treatment much to residual the intersection of tumour and tubercle through reduce the intersection of tumour and skill, can remove the fast-growing tumour tissue while forming a cluster from the slow cells of this kind of growth, a stage hepatocarcinoma is excised in the sample the high persons who split up account for 42.0%. But the high, middle and low person who splits up is 30.8%, 50.0% and 19.2% respectively in this group of hepatocarcinoma, differentiate the cancer proportion and is lower than the literature to report high.

Most scholars think, the indication of reducing the tumour skill should restrict at a stage hepatocarcinoma. Yamamoto,etc.[4]Use the residual tumour index (RTI) =Most big residual the intersection of tumour and most large the intersection of foot-path and * residual the intersection of tumour and number of tubercle of tubercle, and combine the therapeutic effect to obtain: RTI<5.0, having no persons who shift outside liver as the operation indication of reducing the tumour skill. Walk the person who reduces tumour skill should excise the edge 1cm liver of tumour and organize, and excise the cooking stove of satellites at least, residual tumour that can't excise tubercle adopt the intersection of microwave and solidification and absolute alcohol inject skill in the skill.

As to the intersection of a stage and hepatocarcinoma, skill very difficult to judge, could do effecting a radical cure excision, so to this kind of pathological change, depend on, reduce tumour skill result good, should adopt many comprehensive preface of treatment pass through and treat only[4],Including TACE, traditional Chinese medicine, immunization therapy,etc.. To small hepatocarcinoma, the host's immune state has no relations with prognostic; A issue of hepatocarcinoma to developing, it is one of the important factors with bad prognosis that the host's immunity is inhibited. So postoperative immunization therapy is the important step of improving the prognosis[3,5]. To hepatocarcinoma of the unable effecting a radical cure excision, the microwave solidification treatment of residual cancer and tubercle is an effective method in the skill[6]. This group 27 the intersection of patient and competent the intersection of tumour and the intersection of tubercle and person of skill excised account for 70.4%, cancer tubercle excise, add Ultrasonography B lead down residual absolute alcohol of tumour tubercle injector account for 29.6% in the skill, two groups of therapeutic effects do not have statistics difference. We think because liver thick and large, dark parts of small tubercle difficult to lay one's hand on and very particularly liver cirrhosis person, so careful Ultrasonography B is checked, so as not to miss any focus, and lead down absolute alcohol to inject the skill in Ultrasonography B in the skill, it is the key to treating successfully.

There are literature reports[2,3,7], Surgery's therapeutic complication incidence of hepatocarcinoma of a stage is 28.3% - 54.1%, thorax accumulate liquid, ascites and the intersection of liver function and depleted, the intersection of abdominal cavity and abscess, bleed while being postoperative for being getting obstinate mainly, the mortality of operation is 7.7% - 8.4%. A stage hepatocarcinoma is if the curing excision, 1,3,survival rate and - a issue of hepatocarcinoma is similar in 5, it is 92.9%, 77.4%, 53.1% and 88.4%, 70.8%, 51.8% (P> 0.05) respectively[2]; Reduce a postoperative 1 tumour, survival rate is 55.6% - 67.0% and 16.3% - 33.0% respectively in 3[2,8]. Adopt, perform the operation therapeutic a stage hepatocarcinoma, the location of China is life cycle is only 8 weeks. This group surgery complication are 22.0%, do not have operation death and die in hospital. Excise the group and reduce group 1, 2 of the tumour skill, survival rate is 73.3%, 58.3%, 10.0% and 66.7%, 50.0%, 0 (P> 0.05) respectively in 3 ,Total 1, 2, survival rate is 71.4%, 55.6% and 7.7% respectively in 3.

There are literature reports, the factor that influence a stage hepatocarcinoma and surgery treat the prognosis is: (1)Host respect: Liver function Child b, C grade. (2)Tumour: Tumour diameter> 5 cm, the portal vein is invaded, shifts over 3 liver sections in the liver, difference of splitting up of cell. (3)Not curing operation. The multifactor comprehensive analysis results show, tubercle diameter of tumour> 5 cm is the only factor influencing prognosis[8]. A stage hepatocarcinoma with good prognosis may be hepatocarcinoma of many centre origins[2]. This result of study indicates, a stage hepatocarcinoma adopts the surgery therapeutic effect satisfactorily. In other method to under the the intersection of treatment and less than satisfactory situation, a stage of hepatocarcinoma, implement, excise skill and reduce the intersection of tumour and skill, add, treat, can yet be regarded as a good plan while being auxiliary while being other.

Author's unit: Wang ChengFeng (100021 Beijing, belly surgery of tumour hospital of institute of oncology of China Concord Medical Science University of Chinese Academy of Medical Sciences)

Shao YongFu (100021 Beijing, belly surgery of tumour hospital of institute of oncology of China Concord Medical Science University of Chinese Academy of Medical Sciences)

Blue loyal member of a nationality (100021 Beijing, belly surgery of tumour hospital of institute of oncology of China Concord Medical Science University of Chinese Academy of Medical Sciences)

References

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