目的:探讨高龄原发性肝癌患者肝癌根治性切除术的疗效及安全性。方法:回顾性分析63例(高龄组≥70岁)与98例(对照组〈70岁)行肝部分切除术的原发性肝癌患者的一般资料及其围手术期情况,对其术后并发症及预后进行探讨。结果:高龄组术后并发症发生率为36.5%,对照组31.6%(P〉0.05),高龄组7(11.1%)例肝衰竭,2(3.17%)例术后有出血现象,3(4.8%)例切口感染,3(4.8%)例胸腔积液,1(1.5%)例伴有隔下感染,1(1.5%)例有严重肺部感染,由于下肢深静脉血栓脱落,死于急性肺动脉栓塞。组织病理类型高龄组以结节型多见,EdmondsonⅠ-Ⅱ级33例,Ⅲ-Ⅳ级18例,胆管细胞癌8例,混合细胞型4例。BCLC-0、A、B、C期分别占2、9、35、17例。高龄组与对照组1、2、3年生存率分别为82.5%VS85.7%、34.9%VS46.3%、15.9%VS36.8%。结论:高龄对肝部分切除术后并发症的发生并无明显影响,并不是原发性肝癌根治性手术切除术的禁忌症,高龄患者2、3年生存率较对照组低。
Objective: To explore the therapeutic effect and degree of safety in aged patients with primary carcinoma of the liver undergoing radical resection. Methods: The clinical records of 63 patients (older group〉 70years) and 98 patients (younger group〈70 years) with PLC undergoing resection surgery analyzed retrospectively, and the follow-up of these patients was performed, we investigated and discussed the postoperative complications and?the clinical features or prognoses of these people. Results: The post-operative complications (POC) occurred in 23 of older group(36.5%) versus 31 in younger group(31.6%)(P〉0.05), POC occurred in older group of 7 (11.1%) cases of liver failure, 2 (3.17%) cases of postoperative bleeding, 3 (4.8%) cases incision infection, 3(4.8%) cases ofpleural effusion, 1 (1.5%) cases ofsub-phrenic infection, 1 (1.5%)case with severe pulmonary infection. Only one patient died to the acute pulmonary embolism. The histopathology diagnosis showed there were nodes and giant mass type in aged patients, and Edmondson Ⅰ-Ⅱ in 33 patients, Ⅲ-Ⅳ in 18, cholangiocarcinoma in 8, Mixed cellularity in 4. The cases ofBCLC 0, A, B, C phase respectively has 2, 9, 35, 17. The survival rate of older group verses younger group was 82.5%vs85.7%, 34.9%vs46.3%/15.9%vs36.8% at 1, 2 and 3 years, respectively. Conclusion: Advanced age has no obvious effect on the occurrence of POC after hepatectomy and is not a contraindication to radical hepatic resection in patients over 70 years old suffering from early primary liver carcinoma, however, older group patients has lower survival rate than younger group patients in 2 and 3 year.