肝癌合并门静脉高压症联合手术治疗效果观察  

Combined surgical treatment for the patients with Hepatocellular Carcinoma complicated with Portal Hypertension

作　　者：冯伟[1] 林斌[1] 赵东波[1] 胡建平[1] 

机构地区：[1]南京鼓楼医院集团宿迁市人民医院肝胆外科,223800

出　　处：《中国综合临床》2011年第9期981-983,共3页Clinical Medicine of China

摘　　要：目的探讨肝癌合并门静脉高压症联合手术治疗的可行性。方法回顾性分析43例肝癌合并显著食管静脉曲张和脾功能亢进患者的临床资料。全组患者先行原位脾切除术治疗，其中加行选择性门、奇静脉断流术18例。随后行肝切除术治疗，以局部根治或肿瘤所在肝段切除为主。结果本组均采用同期联合手术切除的治疗方式，术后全组患者无死亡。术后出现并发症13例。随访33例，33例患者中1年内死亡3例，生存率90．9％（30／33），3年内死亡12例，生存率63．6％（21／33）。其中死于肝癌复发11例。出现上消化道出血4例。结论联合手术不会增加肝癌伴门静脉高压症患者的手术死亡率，并可减少围手术期出血等致死性并发症，所以施行联合手术是可行的。Objective To explore the practicability of combined surgical treatment for the patients with Hepatocellular Carcinoma（HCC） complicated with Portal Hypertension（PH）. Methods The clinical data of 43 patients with HCC complicated with significant esophageal varices and hypersplenia were analyzed retrospectively. All patients were diagnosed with esophageal varices and hypersplenia of different degrees, 14 of them had severe esophageal varices, the other 29 patients had moderate esophageal varices. Firstly all patients underwent splenectomy, 18 of them had selective portoazygous devascularization in addition. After that the patients received hepatectomys ,with local excision or segmentectomy as the major operation methods. Results All patients received hepateetomy combined with splenectomy treatment. There was no perioperative mortality ,but 12 patients had complications after the surgery. Over seventy percents patients （33/43） accepted regular follow- up. Among these 33 patients,the 1-year and 3-year survival rates were 90. 9% （30/33） and 63.6% （21/33） respectively. Eleven patients died of tumor recurrence. Four patients had upper postoperatively gastrointestinal hemorrhage. Conclusion Hepatectomy combined with splenectomy didn＇t increase the mortality in the patients with HCC complicated with PH. The combined surgery might reduce the incidence of severe complications, such as postoperative bleeding~ We believe the combined surgical treatment is feasible for this group of the patients.

关 键 词：肝癌 门静脉高压症 外科手术 

分 类 号：R735.7[医药卫生—肿瘤]