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中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (01): 11 -15. doi: 10.3877/cma.j.issn.2095-3232.2023.01.003

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肝癌转化治疗后外科切除的必要性和手术时机
元云飞1,()   
  1. 1. 510060 广州,中山大学附属肿瘤医院肝脏外科
  • 收稿日期:2022-11-04 出版日期:2023-02-10
  • 通信作者: 元云飞
  • 基金资助:
    国家自然科学基金(81972301)

Necessity and timing of surgical resection of hepatocellular carcinoma after conversion therapy

Yunfei Yuan1()   

  • Received:2022-11-04 Published:2023-02-10
  • Corresponding author: Yunfei Yuan

肝细胞癌(肝癌)是严重威胁人民健康的恶性肿瘤,2020年全球新发病例数超过90.6万人,死亡83.0万人,分别居恶性肿瘤发病率和病死率的第6位和第3位[1]。目前我国大部分肝癌发现时已属中晚期,治疗效果较差,与欧美和日本等国家相比,总体生存率尚有较大的差距。肝肿瘤切除是根治肝癌的主要方法,对于不能手术切除肝癌,临床医师一直在探讨通过非手术切除方法,使肝肿瘤缩小获得二期(二步)手术切除,即"降期切除"。上海中山医院汤钊猷等[2]于1991年首次在国内报道了不可切除肝癌患者通过术中肝动脉结扎、肝动脉插管化疗、肝动脉灌注131I-抗人肝癌铁蛋白抗体、外放射治疗等治疗手段,成功使33例患者接受手术切除。中山大学肿瘤医院于1997年报道了13例原发性肝癌经过术中肝动脉结扎、无水乙醇注射等方法降期获得二步切除[3]。另有报道不可切除肝癌通过TACE成功使43例患者接受手术切除[4]。研究发现,经过降期切除肝癌患者,其术后5年生存率可达50%~60%,与早期肝癌切除后的生存率相当[5,6]

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