肝细胞癌合并食道静脉曲张破裂出血的联合手术治疗

Combined surgical treatment for hepatocellular carcinoma in cirrhotic patients with esophageal variceal bleeding

目的探讨肝细胞癌(hepatocellular carcinoma,HCC)合并食道静脉曲张破裂出血联合手术治疗的方法、病理生理基础和治疗效果。方法选取1999年12月—2007年12月采用肝部分切除联合脾切除、门奇断流术治疗HCC合并食道静脉曲张破裂出血患者共23例(联合手术组),观察术前、术后外周血白细胞和血小板计数的变化、食管静脉曲张缓解情况、生存率和肿瘤复发率;并与同期行单纯肝切除术的39例HCC患者(单纯肝切除组)进行比较分析。结果联合手术组手术并发症和手术死亡率与单纯肝切除组相比差异无统计学意义;联合手术组术后白细胞及血小板计数回升明显,显著高于单纯肝切除组;已随访14例患者中,13例食道静脉曲张改善;随访期间无凶险感染发生;5年生存率和3年肿瘤复发率2组间比较,差异无统计学意义。结论对于HCC合并食道静脉曲张破裂出血,采用肝部分切除联合脾切除、门奇断流术进行治疗是安全有效的,联合脾切除、门奇断流术并不增加肝切除手术的风险,不影响远期生存率和肿瘤复发率。

Objective To explore the methods, physiopathological basis and the effect of combined surgical treatment on hepatocellular carcinoma（HCC） in cirrhotic patients with esophageal variceal bleeding. Methods Among the cirrhotic patients who underwent liver resection for HCC between Dec. 1999 and Dec. 2007, 23 underwent a concomitant splenectomy and disconnection because of esophageal variceal bleeding （combined surgical group）. The changes in white blood cell counts and platelet counts before and after the operation, the improvement of esophageal varices, the survival rate and the reccurrence rate were observed and compared with those of the other pairing 39 cirrhotic patients who only underwent liver resection （only-LR group）. Results The postoperative complications and mortality were not significantly different between the two groups. The white blood cell counts and the platelet counts increased in combined surgical group, significantly higher than those in only-LR group. The improvement of esophageal varices was confirmed inl3 of 14 follow-up cases. No overwhelming infections occurred in the follow-up. Five-year survival rate and 3-year reccurrence rate were not significantly different between the two groups. Conclusions Liver resection for HCC combined with splenectomy and disconnection is safe and effective for cirrhotic patients with esophageal variceal bleeding. Concomitant splenectomy and disconnection is justified not to increase the risk of liver resection, or affect long-term survival rate and reccurrence rate.