联合脾脏切除治疗原发性肝癌合并门静脉高压症的临床分析  

Allied resection of liver and spleen surgical treatment of primary hepatic carcinoma associated with portal hypertension

作　　者：周益龙[1] 邵冰峰[1] 徐爱兵[1] 张素青[1] 周元[1] 张一心[1] ZHOU Yilong SHAO Bingfeng XU Aibing ZHANG Suqing ZHOU Yuan ZHANG Yixin(Department of Hepatology, Nantong Tumor Hospital, Jiangsu Province, Nantong 226361)

机构地区：[1]江苏省南通市肿瘤医院肝胆科,南通226361

出　　处：《南通大学学报（医学版）》2016年第5期420-424,共5页Journal of Nantong University(Medical sciences)

基　　金：南通市科技计划(指导性)项目(S11907);南通市科技项目(K2010011)

摘　　要：目的:探讨肝脾联合切除在原发性肝癌合并门静脉高压症治疗中的手术技巧及临床价值。方法 :回顾性分析本院自2010年1月—2014年12月收治的原发性肝癌合并门静脉高压症患者66例,其中24例行肝脾联合切除(其中13例附加食管下段贲门周围血管离断术),为肝脾联合切除组;22例仅行肝癌切除,为单纯手术切除组;20例行肝动脉栓塞化疗加脾动脉部分栓塞术(其中6例先行肝肿瘤射频消融术),为介入治疗组。结果:所有肝脾联合切除组患者围手术期均无死亡,术后脾功能亢进症状明显缓解,并发症与单纯手术切除组及介入治疗组相比差异无统计学意义,手术远期疗效明显优于单纯手术切除组及介入治疗组。结论:肝脾联合切除术对于原发性肝癌合并门静脉高压症治疗效果较好,尤其对于后续治疗意义重大。Objective： To investigate the surgical technique and clinical efficacy of allied resection of liver and spleen in treatment of primary hepatic carcinoma associated with portal hypertension. Methods： Clinical data of 66 patients in our hospital from January 2010 to December 2014 with primary hepatic carcinoma associated with portal hypertension. Among the total, 24 patients were performed allied resection of liver and spleen and 13 cases of them were also performed esophago inferior segment cardia peripheral vessels chop amputation; 22 patients were performed hepatoma-ectomy; 20 patients were performed transcatherter hepatic arterial chemo- embolization（ TACE） plus partial splenic embolization（ PSE） and 6 cases of them were performed liver neoplasm radiofrequency ablation in advance. The patients were described as merely surgical ablation group, allied resection group and interventional therapy group respectively. Results： All the patients performed allied resection of liver and spleen were alive during the perioperative period and the hypersplenia symptoms of them were significantly improved after the surgery. There＇s no significant difference in the complication between the allied resection group and the merely surgical ablation group or interventional therapy group. The prostecdtive efficacy of allied resection of liver and spleen was obviously superior to the other two groups. Conclusion： The allied resection of liver and spleen had better treatment effectiveness to primary hepatic carcinoma associated with portal hypertension, especially in the aspect of subsequent treatment.

关 键 词：原发性肝癌 门静脉高压 外科手术 介入治疗 

分 类 号：R735.7[医药卫生—肿瘤]