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題 名 | 原發性肝癌的大量肝切除 |
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作 者 | 林炳文; 魏達成; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 19:3 1986.07[民75.07] |
頁 次 | 頁200-207 |
分類號 | 416.246 |
關鍵詞 | 原發性肝癌; 大量肝切除; |
語 文 | 中文(Chinese) |
中文摘要 | 近9年來,在台大醫院有46例原發性肝癌,以控制方法施行大量肝切除術。病人最年輕者19歲,最年長者69歲。男女之比為5.57比1。這群病人的肝癌多屬較大型。B型肝炎表面抗原之陽性率為73.8%,肝硬化之合併率為38.6%,α胎兒蛋白之陽性率為50%。46例中,施行右肝葉切除術有23例,左肝葉切除術有16例,擴大右肝葦切除術有6例,擴大左肝葉切除術有1例。術中失血量之多寡與肝硬化之有無,統計學上並無顯著的相關(p>0.05)。3例(6.5%)屬手術死亡例,皆為肝硬化患者。10例(21.7%)術後發生橫隔下積膿,膽汁瘻管,肋膜積水等併發症。除1例橫隔下膿瘍需藉外科手術引流外,其餘皆可在超音波導引下作引流,或以其他保守性療法而治癒。追踪至1985年10月,有21例死亡,25例尚存。除去3例手術死亡,已死亡病例之平均存活期為11.2個月。肝硬化與非肝硬化之死亡例之平均存活期分別為7.9個月與13.8個月,統計學上無顯著相差(P>0.05)。有衛星腫瘤與無衛星腫瘤之死亡例之平均存活期分別為6.2個月與16.1個月,統計學上亦無顯著相差(P>0.05)。腫瘤大小與存活期,並無線性相關(r=1.36x10-4)。 未經治療的肝癌,平均存活期很短。對可切除的腫瘤,採用外科手術予以切除,仍是最優先考慮的治療方法。本報告的手術死亡率很低,可是併有肝硬化和有衛星腫瘤的肝癌,其預後仍是不佳。 |
英文摘要 | In recent 10 years (1976-1985), 46 patients with primary hepatocellular carcinoma underwent major hepatic resections with control method at the Department of Surgery, National Taiwan Univerity Hospital. There were 39 males and 7 females, with a male to female ratio of 5.57. Their ages ranged from 19 to 69 years old. The tumor size was generally large, and ranged from 5 to 25 cm at largest diameter. Frequency of positive HBsAg and £-fetoprotein were 73.8% and 50% respectively. Liver cirrhosis was pathologically proved in 38.6%. Among 46 patients, 23 received right lobectomy, 16 left lobectomy, 6 extended right lobetomy and one extended left lobectomy. There was no any significant difference between cirrhotic and noncirrhotic cases in intraoperative blood loss. Three operative deaths, all of the cirrhotic patients, resu1ted in an operative mortality rate of 6.5%. Ten patients (21.7%) developed postoperative subphrenic accumulation and/or bile leakage and/or pleural effusion. All the postoperative complications except one needed surgical drainage of subphrenic abscess, but could be managed well with conservative procedures. Exclusive of the 3 operative deaths, there were 21 deaths and 25 still alive cases in the followup period. The mean survival time among these death cases was 11.2 months; it was 7.9 months for the 8 cirrhotics and 13.8 months for 10 noncirrhotics. The mean survival time of the 9 mortalities with satellite nodules was 6.2 months, and was 16 months for 8 nonsate1lite nodule patients. The mean survival of the untreated hepatoma is short and surgical removal of the resectable tumors is still generally accepted as the frrst choice of treatment. Though the operative mortality rate in this series remains low, the prognosis for cases of large hepatoma associated with cirrhosis and sate1lite nodules is still poor. This paper represents a retrospective study of personal experience with using major hepatic resection for primary hepatoma. |
本系統中英文摘要資訊取自各篇刊載內容。