原发性肝癌合并重度肝硬化的外科治疗

Surgical treatment of primary liver cancer with severe cirrhosis

目的探讨原发性肝癌合并重度肝硬化外科治疗的方法及疗效。方法自2004年2月至2008年1月间共收治原发性肝癌合并重度肝硬化患者38例,术前以Child-Pugh分级及ICG评价肝脏功能,加强围手术期处理,术中先行脾动脉缩窄、贲门周围离断术,再根据肿瘤大小及部位选择手术方案,其中行肝癌切除术者21例,肝射频消融术11例,肿瘤部位纯酒精注射6例。结果38例患者术后1、2、3年生存率分别为89.5%(34/38)、81.6%(31/38)和57.9%(22/38),手术并发症为腹水及一过性黄疸。结论对原发性肝癌合并重度肝硬化患者在加强围手术期的同时行脾动脉缩窄贲门周围血管离断术,应根据肿瘤大小及部位选择手术方案,可以有效地治疗肿瘤,避免严重的并发症,提高患者的生存质量及延长生存期。

Objective To explore the methods and their effects of surgical treatment on primary liver cancer with severe cirrhosis. Methods From February 2004 to January 2008, a total of 38 primary liver cancer patients with severe cirrhosis were surgically treated in our hospital. Liver functions were evaluated by Child＇s classification and ICG preoperatively. In addition, perioperative management was strengthened. During the operation, contract of splenic artery was performed and then operational approaches were selected according to sizes and sites of the tumor （including hepatectomy in 21 patients and radiofrequcnce ablation in 11 patients）. Results The 1-, 2-, 3- year survival rate of these patients was 89.5%, 81.6% and 57.9% respectively. The operative complications were ascites and temporary jaundice. Conclusion For primary liver cancer patients with severe cirrhosis, strengthening of perioperative management, contract of splenic artery and then selection of operative approaches according to tumor size and site are important for effectively treating the tumor, avoiding severe operative complications, improving patients＇ life quality and prolonging their survival.