影响肝癌肝切除术后远期预后的手术相关因素

摘要

肝切除术仍是肝癌的主要根治性手段.除肿瘤侵袭性因素、肝脏因素和机体因素外,手术类型、切缘宽度以及术中失血和输血都可能影响病人的术后远期生存.肝切除术应以R0切除为目标,根据个体的肿瘤负荷、肿瘤位置和肝脏功能状况选择实施不同的手术类型和切缘宽度.在确保足够的功能性剩余肝体积的前提下,对低分化、局部或伴有微血管侵犯的肝癌,可优先考虑解剖性肝切除和宽切缘切除.术前应仔细评估和精确规划,术中精细操作结合低中心静脉压和血流控制技术,尽可能地减少术中失血和输血,确保手术的安全实施和术后顺利恢复.%Liver resection remains the first-line treatment of hepatocellular carcinoma (HCC).In addition to the factors associated with tumor invasiveness,liver function and general performance,the type of liver resection,the width of surgical margins and intraoperative blood loss might affect the patient's long-term survival after surgery.With an intention of achieving an R0 resection,resection types and surgical margin should be carefully selected based on the tumor burden,tumor location and liver functional reserve.On the premise of ensuring a sufficient functional liver remnant,an anatomical or a wide margin resection may benefit for patients with poorly differentiated tumor,or with local or microvascular invasion.The accurate preoperative assessment and the operation using low central venous pressure and proper blood flow control technique to reduce intraoperative blood loss may provide more chance to achieve optimal surgical safety and long-term survival.