肝癌98975.ppt

* * * * * * The recurrence after operation remained to be a big problem. The results derived from different studies got similar conclusion: Recurrence rates within 5 years: 60% * * DFS disease free survival; OS: overall survival VIII Segment tumor CASE-1 CUSA resection protect MHV VI, VII, VIII Segment tumor CASE-2 CUSA resection plane CASE-4 CASE-5 Author country year survival rate（%） n 1y 3y 5y Nagao Japan 1987 98 73 42 25 Chen Taiwan 1997 382 71 52 46 Lee Taiwan 1998 245 86 62 49 Belghiti French 2002 300 81 57 37 Ercolani Italy 2003 224 83 63 43 Lai HK 1995 343 68 45 35 Takenaka Japan 1996 280 88 70 50 Poon HK 2001 241 82 62 49 Zhou China 2001 2366 82.6 61 49.7 Wu China 2005 6446 85.9 64.6 53.2 肝癌手术治疗效果 Author n Recurrence Rates (%) 1 3 5 XD Zhou 308 9.2 38.8 54.1 Imamura H 249 30.1 62.3 79.0 Wakai T 111 28 49 62.0 F SHEN 823 30.3 58.8 66.5 肝癌术后复发率 ?肝癌≤2cm，单发，无血管侵犯，采用手术切除 或RFA或PEI疗效均相仿 ≤5cm的小肝癌，施行手术切除后5年生存率约为50%左右。 ?上海中山医院周信达报道1000例小肝癌手术切除后 5年、10年生存率分别为65.1%和46.6%。 ?东方肝胆医院1960年-1996年709例小肝癌手术切除后 5年生存率为79.8%， 小肝癌切除 Conversion of tumor from unresectable to resectable. (a) Computed tomographic (CT) scan obtained in the late arterial phase shows a large HCC in a patient without cirrhosis. The initial attempt at resection was unsuccessful. (b) CT scan obtained after two chemoembolization sessions shows marked tumor shrinkage. (c) Follow-up CT scan obtained 9 months after resection of segments IVa and V. No residual tumor is identified. 原发性肝癌二期切除 上海中山医院周信达报道99例， 5年生存率达63.5% 上海东方肝胆医院73例， 5年生存率达61.5% 肝癌二期切除效果 　　只要肝功能良好，技术条件具备，有手术切除可能的复发肝癌，均应争取先手术切除，术后再采用综合治疗措施。 原发性肝癌复发再切除 同时解决肝癌和肝硬化。 “意外癌”患者的肝移植后3年生存率可达70% 肝癌肝移植 Milan UCSF Chinese criteria Milan Criteria(1996，Mazzaferro) single lesion ≤ 5cm or ≤ 3 lesions, none 3cm UCSF Criteria ： Solitary lesions ≤6.5 cm