原发性肝癌合并肝硬化门静脉高压症的手术治疗43例  

Surgical treatment of patients with hepatocellular carcinoma and portal hypertension:an analysis of 43 cases

作　　者：罗永香[1] 李川[2] 文天夫[2] 严律南[2] 李波[2] 

机构地区：[1]广西钦州市第一人民医院普外二科,广西壮族自治区钦州市535000 [2]四川大学华西医院肝移植中心,四川省成都市610041

出　　处：《世界华人消化杂志》2010年第33期3576-3579,共4页World Chinese Journal of Digestology

基　　金：四川省科技支撑计划基金资助项目;No.2009SZ0172~~

摘　　要：目的:探讨原发性肝癌合并肝硬化门静脉高压症患者的手术方式.方法:对43例患者临床资料进行回顾性分析,将其分为单纯肝切除组(A组)、肝切除+脾切除组(B组)及肝切除+脾切除+断流组(C组),比较3组肝功能分级、肝硬化程度、术前与术后血常规及肝功能变化、术后并发症等指标.结果:A组易出现腹水,B、C组血小板及白细胞术后回升明显(257.1×109/L±48.3×109/Lvs48.7×109/L±24.9×109/L,227.1×109/L±46.1×109/Lvs47.8×109/L±18.8×109/L;12.3×109/L±2.4×109/Lvs3.1×109/L±1.4×109/L,11.9×109/L±2.4×109/Lvs2.8×109/L±1.6×109/L,均P<0.05).A组并发症发生率较B+C组增高,有显著性差异(64.3%vs27.6%,P<0.05).肝功能ChildB级术后易出现并发症,其发生率较ChildA级明显升高(85.7%vs22.2%).结论:原发性肝癌合并肝硬化门静脉高压脾亢患者可同期行肝癌+脾切除术,同期行肝癌+脾切除术+贲门周围血管离断术应严格掌握手术指征.AIM： To evaluate the efficacy and safety of surgical management of hepatocellular carcinoma with portal hypertension. METHODS： The clinical data for 43 patients with hepatocellular carcinoma and portal hypertension who were treated from 2006 to 2010 were retrospectively analyzed. Of all the patients, 13 were treated by combined pericardial devascu- larization, splenectomy and hepatic resection, 16 by combined splenectomy and hepatic resection, and 14 by hepatic resection alone. Postoperative laboratory parameters and surgical complications were analyzed in these patients.RESULTS： Ascites was apt to occur in patients who underwent hepatic resection alone. White blood cell and platelet counts increased signifi- cantly in patients who received splenectomy （257.1 x 10^9/L ＋ 48.3 x 10^9/L vs 48.7 x 10^9/L ＋ 24.9 x 10^9/L, 227.1 x 10^9/L ＋ 46.1 x 10^9/L vs 47.8 x 10^9/L ＋ 18.8 x 10^9/L; 12.3 x 10^9/L ＋ 2.4 x 10^9/L vs 3.1 x 10^9/L ＋ 1.4 x 10^9/L, 11.9 x 10^9/L ＋ 2.4 x 10^9/L vs 2.8 x 10^9/L ＋ 1.6 x 10^9/L, all P 〈 0.05）. The incidence of postoperative complications was significantly higher in patients undergoing hepatic resection alone than in the other two groups of patients （64.3% vs 27.6%, P 〈 0.05）. The rate of postoperative complications was significantly higher in patients who had grade B liver function than in those who had grade A liver function （85.7% vs 22.2%）. CONCLUSION： Combined hepatic resection and splenectomy are an efficient and safe method for management of patient with hepatocellular carcinoma and portal hypertension. The indications for combined pericardial devascularization, splenectomy and hepatic resection should be applied strictly.

关 键 词：原发性肝癌 门静脉高压 脾功能亢进 脾切除术 贲门周围血管离断术 

分 类 号：R735.7[医药卫生—肿瘤] R575.2[医药卫生—临床医学]