原发性肝癌合并严重肝硬化门脉高压的外科处理

SURGICAL HANDLING OF PRIMARY HEPATIC CARCINOMA WITH SEVERE CIRRHOSIS AND PORTAL HYPERTENSION

回顾性分析６３例原发性肝癌合并严重肝硬化的外科处理。提出术前评估肝硬化程度及肝功能贮备的必要性。推荐“三联手术”，即在处理原发病灶手术基础上对门脉高压和脾亢行脾动脉结扎加胃底贲门周围静脉结扎术；强调围手术期常规应用速尿、抗酸药、胰岛素等。结果：按此原则处理的３２例患者三年生存率达５７％。故认为“三联手术”代替脾切除是处理原发性肝癌合并严重肝硬化时防治消化道出血和脾亢的首选方法。

our hundred and ninty eight cases of primary hepatic carcinoma(PHC) were discovered complicating with cirrhosis in 608 PHC cases during 1974～1994. 63 cases of them were with severe cirrhosis and portal hypertension (10.4%). Laparotomy indication was evaluated according to Child's grade and image data such as BUS and CT etc. Operative extension should be limited as segment or wedge hepatectomy or semihepatic artery chemoembolization. Splenic artery ligation plus venous ligalion of cardiac region of stomach were applied to portal hypertension and hypersplenism. Frusemide, antacid and insuline were used in the perioperation period. Threeyear survival rate was 57%. It is considered that splenic artery ligation instead of splenectomy is the first choice for preventing and treating hypersplenism and digestive tract bleeding in PHC with severe cirrhosis.