肝癌切除联合选择性减断流术治疗原发性肝癌合并门静脉高压的效果观察  

Clinical effect of liver cancer resection combined with selective decongestive devascularization in treatment of primary liver cancer complicated by portal hypertension

作　　者：郑桂龙 丁海华[1] 丁志清[1] 邓先仁 夏静波[1] 李宏欣[1] 

机构地区：[1]镇江市第二人民医院,江苏镇江212002

出　　处：《临床肝胆病杂志》2016年第11期2121-2125,共5页Journal of Clinical Hepatology

摘　　要：目的探讨肝癌切除联合选择性减断流术在原发性肝癌合并门静脉高压中的治疗效果。方法回顾性分析2013年3月-2016年2月在镇江市第二人民医院接受治疗的60例原发性肝癌合并门静脉高压患者的临床资料。根据手术方式不同分为A组(32例)和B组(28例),其中A组采用肝癌切除联合脾切除贲门周围血管离断术,B组采用肝癌切除联合选择性减断流术。观察两组患者围手术期一般情况,比较两组患者手术前后免疫功能指标、肝功能指标和并发症发生率的差异。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果 B组患者手术时间较A组长[(135.27±15.13)min vs(118.35±12.56)min],住院时间较A组短[(14.28±2.95)d vs(16.37±3.42)d],差异均有统计学意义(t值分别为-4.733、2.516,P值分别为<0.001、0.007)。术后1个月,B组患者的Ig G、Ig M和Ig A水平明显高于A组[(14.98±3.12)vs(12.51±2.75)、(2.79±1.13)vs(2.25±1.02),(2.42±0.79)vs(1.87±0.82)],差异均有统计学意义(t值分别为-3.260、-1.945、-2.636,P值分别为<0.001、0.028、<0.005)。术后1个月,A组PLT水平增加较B组明显[(302.46±15.08)×109/L vs(80.25±5.68)×109/L,t=73.481,P<0.001]。两组患者术后并发症发生率差异无统计学意义(18.75%vs 17.86%,χ2=0.008,P=0.929)。结论肝癌切除联合选择性减断流术在改善患者肝功能的同时,可使患者维持较好的免疫功能,具有临床应用价值。Objective To investigate the clinical effect of liver cancer resection combined with selective decongestive devascularization in the treatment of primary liver cancer complicated by portal hypertension. Methods A retrospective analysis was performed for the clinical data of 60 patients with primary liver cancer complicated by portal hypertension who were treated in The Second People＇s Hospital of Zhenjiang from March 2013 to February 2016. According to the surgical procedure,the patients were divided into group A（ 32 patients） and group B（ 28 patients）. The patients in group A were given liver cancer resection combined with splenectomy,and those in group B were given liver cancer resection combined with selective decongestive devascularization. The patients＇ general status in the perioperative period were observed,and immune function parameters and liver function parameters were compared between the two groups before and after surgery,as well as the incidence of complications. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results Compared with group A,group B had a significantly longer time of operation（ 135. 27 ± 15. 13 min vs 118. 35 ± 12. 56 min,t =- 4. 733,P〈0. 001） and a significantly shorter length of hospital stay（ 14.28 ± 2. 95 d vs 16. 37 ± 3. 42 d,t = 2. 516,P = 0. 007）. At 1 month after surgery,group B had significantly higher levels of Ig G,Ig M,and Ig A than group A [（ 14. 98 ± 3. 12） vs（ 12. 51 ± 2. 75） 、（ 2. 79 ± 1. 13） vs（ 2. 25 ± 1. 02）,（ 2. 42 ± 0. 79） vs（ 1. 87 ± 0. 82）,t =- 3.260,- 1. 945,and- 2. 636,P〈0. 001, = 0. 028,and 0. 005]. At 1 month after surgery,both groups showed significant increases in platelet count（ t =- 89. 590 and- 20. 261,both P〈0. 001）,and group A showed a significantly greater increase than group B [（ 302. 46± 15. 08） × 10^9/ L vs（ 80. 25 ± 5. 68） × 10^9/ L,t = 73. 481,P〈0. 001]. There w

关 键 词：肝肿瘤 高血压 门静脉 外科手术 治疗 

分 类 号：R735.7[医药卫生—肿瘤]