联合手术治疗原发性肝癌伴严重门脉高压症的手术安全性

Operation safety in combined surgery for the treatment of primary hepatocellular carcinoma associated with severe portal hypertension

目的探讨联合手术(肝癌切除术联合脾切除术、门奇静脉断流术)治疗原发性肝细胞癌伴门静脉高压症患者的安全性和有效性。方法将1999年4月至2004年4月间我科收治的116例原发性肝细胞癌伴或不伴门静脉高压症患者分为3组,联合手术组为肝癌伴严重门脉高压症行联合手术的患者,对照Ⅰ组为肝癌伴轻度门脉高压症行肝癌切除术的患者,对照Ⅱ组为肝癌不伴门脉高压症行肝癌切除术的患者;对比各组临床资料及远期随访结果。结果116例患者仅对照Ⅰ组的1例术前肝功能评分为Child C级患者发生围手术期死亡;联合手术组术后腹水发生率高于对照Ⅱ组。3年随访中116例患者共死亡63例;联合手术组远期出血率明显低于对照Ⅰ组;Kaplan-Meier生存分析提示联合手术组与对照Ⅱ组的远期生存相仿,而无论是联合手术组还是对照Ⅱ组的远期生存率都优于对照Ⅰ组。结论联合手术是治疗原发性肝癌伴严重门静脉高压症患者的安全有效手段;对伴轻度门脉高压的肝癌患者仅行肝切除术,其术后出血率较高,远期生存率较差,故对此类肝癌患者亦应重视门静脉高压症的治疗。

Objective To evaluate the safety and efficacy of the combined surgery for the treatment of pri,＂mary hepatocellular carcinoma （HCC） and portal hypertension （PHT）. Methods From April 1999 to April 2004, the clinical data of total 116 HCC patients with or without PHT were analyzed retrospectively. The pa,＂tients were divided into 3 groups, the case group was the patients receiving combined operations while the control group Ⅰ and Ⅱ included the patients receiving single hepatectomy. Results During the perioperative period, all the patients encountered no death with the exception of one patient ranking Child C in control group Ⅰ. The incidence of ascites was higher in the case group after surgery. By the end of follow-up, a total of 63 patients died, the 1, 2, and 3-year postoperative hemorrhagic rates in the case group were lower than that in control group Ⅰ. In the Kaplan-Meier analysis, there was no statistical significance in the long time survival between the case group and the control group Ⅱ. However, both the above survival rates were more encouraging than the control group Ⅰ. Conclusion Hepatectomy combined with portaazygous devascularization and splenectomy are safe and feasible for patients with hepatic carcinoma associated with severe portal hypertension. The higher hemorrhagic rates and lower survival rates of the HCC patients with mild PHT after single hepatectomy suggest that combined surgery should also be applied for these patients.