肝癌合并门静脉高压症的外科治疗  

Surgical treatment for hepatocellular carcinoma and concomitant portal hypertension.

作　　者：张宗利[1] 胡继康[1] 靳祖涛[1] 

机构地区：[1]山东大学齐鲁医院普外科,济南250012

出　　处：《中国实用外科杂志》2002年第2期85-87,共3页Chinese Journal of Practical Surgery

摘　　要：目的　探讨肝癌并门静脉高压症外科治疗的方法与疗效。方法　回顾分析 1992～ 1998年经手术治疗的肝癌合并门静脉高压症病人 6 2例。一期手术组 17例 ,在切除肝癌病灶的同时行脾切除 +门奇静脉断流术9例 ;在切除癌灶的同时仅作脾切除术 8例。另组 45例 ,只行肝癌切除。结果　一期手术组 (n =17)术后 7天死亡 1例 ,严重心肺并发症及多量腹水各 1例。术后 1、2、3年生存率分别为 94%、5 3%、44 %。死亡原因依次是肝癌复发、肝功能衰竭、上消化道出血。仅行肝癌切除组 (n =45 )术后死亡 2例 ,术后 1、2、3年生存率分别为95 6 %、6 0 %、37% ,死亡原因依次是肝癌复发 ,上消化道出血 ,肝功能衰竭。结论　肝癌合并门静脉高压症一期手术治疗是安全可行的 ,适用于肝功能良好的小肝癌病人 ;ObjectiveTo investigate the method and effect of surgical treatment for hepatocellular carcinoma(HCC)and concomitant portal hypertension.MethodsRetrospective analysis was made on 62 cases of hepatocellular carcinoma and concomitant portal hypertension that received surgical treatment from 1992 to 1998.They were divided into two groups.Group 1 with 17 cases,of which,the liver cancer was resected first,then 9 cases were concurrently treated by splenectomy plus portaazygous devascularization and the other 8 cases by splenectomy.Group 2 with 45 cases was treated by hepatectomy.ResultsIn group 1, 1 case died 7 days after operation,1 case was complicated with severe heart and lung disease,1 case got a mount of ascites.The 1-?2-?3- year survival rates were 94%?53%?44%respectively.The causes of death were cancer recurrence?liver failure and upper gastrointestinal hemorrhage.In group 2,1 case died of liver failure,another of bleeding.The 1-?2-?3- year survival rates were 95.6%?60%?37% respectively.The causes of death were cancer recurrence?upper gastrointestinal hemorrhage and liver failure.ConclusionThe concurrent operations can be safe and feasible to be carried out on patients with small HCC and concomitant portal hypertension.Prophylactic operation is not advocated.

关 键 词：肝细胞癌 门静脉高压症 脾切除术 门奇静脉断流术 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤] R657.34[医药卫生—临床医学]