切除肝癌联合定量微波消融治疗脾功能亢进患者术后并发症的相关因素分析  

Analysis of risk factors for postoperative complications of hepatectomy combined with microwave ablation of spleen in the treatment of splenomegaly and hypersplenism with liver cancer

作　　者：易永祥[1] 胡亮[1] 韩建波[1] 赵亮[1] 张郁峰[1] 刘俊卯[1] 张继宗[1] 殷国平[1] 

机构地区：[1]南京市第二医院普通外科,210003

出　　处：《中华老年医学杂志》2014年第9期969-972,共4页Chinese Journal of Geriatrics

基　　金：南京市医学科技发展课题（YKK10057）;江苏省六大人才高峰（2010-WS-060）

摘　　要：目的 探讨切除肝癌联合定量微波消融治疗脾功能亢进患者术后并发症发生的危险因素. 方法 回顾我院90例因肝癌及门静脉高压行肝癌切除术联合定量微波消融术治疗脾功能亢进患者,分析术后并发症发生率及相关因素. 结果 术后并发症发生率为27.8％（25/90）.术后并发症主要有胸腔积液及胸腔积液感染、胆漏、肝脏功能不全、肺部感染、术后出血及术后因再出血行第二次手术、肝性脑病、切口出血、切口液化或感染等.术后并发症发生率与肿瘤大小、肝脏功能Child-pugh分级以及慢性肝炎严重程度呈正相关（P＜0.05）.肿瘤越大、肝脏功能越差以及慢性肝炎越严重,术后并发症发生率越高. 结论 术前及术后加强围术期处理,改善肝脏功能,提高肝脏功能储备,可减少术后并发症发生.肝癌切除术联合定量微波消融术治疗脾功能亢进患者术后并发症发生率低于常规肝癌切除合并脾脏切除术的患者.Objective To analyze the relevant factors for postoperative complications of hepatectomy combined with microwave ablation of spleen in treatment of splenomegaly and hypersplenism with liver cancer.Methods 90 patients with hepatocellular carcinoma and portal hypertension who underwent hepatectomy combined with microwave ablation of spleen were retrospectively studied.Postoperative complications and their risk factors were analyzed.Results 27.8％ （25/90）of patients had postoperative complications.The main complications were pleural effusion and infections,bile leakage,liver dysfunction,pulmonary infection,postoperative bleeding and reoperation for postoperative bleeding,hepatic encephalopathy,incision bleeding,incision liquefaction or infection.The incidence of postoperative complication was positively correlated with tumor size,hepatic function according to grade of Child-pugh,and severe degree of chronic hepatitis.Conclusions Postoperative complicationscan be reduced by enhancing perioperative treatment,improving liver function and liver function reserve.Postoperative complications of hepatectomy combined with microwave ablation of spleen are less than those of conventional hepatectomy combined with splenectomy.

关 键 词：肝肿瘤 肝切除术 脾功能亢进 手术后并发症 

分 类 号：R735.7[医药卫生—肿瘤]