肝细胞癌外科治疗方式的研究进展

摘要

The surgical treatment of hepatocellular carcinoma have advanced greatly in recent years: associating liver partition and portal vein ligation for staged hepatectomy can bring hope and relief to patients with advanced liver cancer and less future liver remnant;the application range of laparoscopic hepatectomy and robotic hepatectomy were amplified;hepatectomy following anatomic or non-anatomic direction should be decided by particular situations;the precise preoperative assessment of liver reserve function ensured the success of extended hepatectomy;the further discussion of United Network for Organ Sharing criteria for liver transplantation made the appearance of University of California at San Francisco, Up-to-seven and Hangzhou criteria;bridge therapy can decrease tumor progression and the dropout rate from the liver transplantation waiting list;downstaging treatment is used in selected patients with more advanced liver cancer who are beyond the accepted transplant criteria to acquire the chance of liver transplantation and increase survival rates.%外科手术是肝细胞癌的根治性治疗方法,主要包括肝部分切除术及肝移植.肝细胞癌外科治疗方式的进展体现在以下几方面,即联合肝脏离断和门静脉结扎的二步肝切除术为晚期肝细胞癌且残余肝体积较小的患者带来希望;腹腔镜肝切除术和机器人肝切除术的应用范围进一步扩大;肝切除术遵从解剖性还是非解剖性应视患者情况而定;术前肝脏储备功能的精确评估确保了极量肝切除术的成功;对肝移植美国器官共享网络规则的进一步探讨促进了University of California at SanFrancisco规则、Up-to-seven规则及中国"杭州标准"的出现;桥接治疗减缓了肿瘤进展,降低了肝移植候选人被移出移植候选名单的可能性;降期治疗使部分超出移植规则的晚期肝细胞癌患者有机会进行肝移植并提高了存活率等.