肝癌切除附加脾切除、门奇断流治疗肝癌合并门脉高压症(附67例报告)

Limited hepatectomy in combination with portaazygous devascularization and splenectomy for patients with hepatic carcinoma accompanied by portal hypertension

目的 通过总结 6 7例接受肝癌局部根治性切除附加门奇断流、脾切除治疗的肝癌伴门脉高压、脾功能亢进病人的临床资料 ,并进行术后随访 ,探讨对肝癌伴门脉高压、脾功能亢进病人进行肝癌局部根治性切除附加门奇断流、脾切除手术的疗效以及手术可行性、适应证和围手术期注意事项。方法 回顾性分析我院 1996年 1月至 2 0 0 2年 12月底的该组临床资料 ,并进行电话随访。结果 术后 30d内死亡 3例 ,总并发症发生率为 2 6 9% (18/ 6 7)。术后出现上消化道出血发生率 2 3 0 %(14 / 6 1)。 1、3、5年绝对生存率分别为 77 6 % (45 / 5 8)、4 1 2 % (14 / 34)、35 7% (5 / 14 )。至 2 0 0 3年 4月底 ,死亡 2 8人 ,除术后 30d内死亡的 3人外 ,死于肿瘤复发、转移导致全身衰竭死亡者 15例 ,占 5 3 6 %(15 / 2 8) ;死于上消化道大出血者 3例 ,占 10 7% (3/ 2 8) ;死于肝功能衰竭者 5例 ,占 17 9% (5 / 2 8) ;其他原因死亡者 2例 ,占 7 1% (2 / 2 8)。结论 在严格掌握手术适应证的前提下 ,通过熟练的手术配合和细致的手术操作 ,以及合理的围手术期处理 ,对肝癌合并门脉高压、脾功能亢进病人进行肝癌局部根治性切除附加门奇断流、脾切除术是可行的。

Objective To evaluate the effects, feasibility and indications of limited hepatectomy in combination with portaazygous devascularization and splenectomy for patients with hepatic carcinoma accompanied by portal hypertension. Methods The clinical data of 67 patients with hepatic carcinoma accompanied by portal hypertension receiving limited hepatectomy in combination with portaazygous devascularization and splenectomy from January 1996 to December 2002 in our hospital were retrospectively analyzed. Meanwhile, all the patients were followed up by telephone. Results Three patients died in 30 d after the operation. Postoperative complications developed in 18 patients (26 9%). Postoperative upper digestive tract hemorrhage developed in 14 patients (23 0%. The absolute 1 , 3 and 5 year survival rates were 77 6% (45/58), 41 2% (14/34) and 35 7% (5/14), respectively. By the end of April 2003, 28 patients died. Besides the 3 patients died within 30 d after operation, 15 (53 6%) died of cancer recurrence or metastasis, 3 (10 7%) of upper digestive tract hemorrhage, 5 (17 9%) of liver failure and 2 of other causations in the follow up period. Conclusions Under the conditions of suitable selection of indications, perfect operative procedure and proper perioperative treatments, limited hepatectomy in combination with portaazygous devascularization and splenectomy is safe and feasible for patients with hepatic carcinoma accompanied by portal hypertension.