经皮微创射频消融无水酒精注射联合脾切除术治疗小肝癌合并重度门静脉高压脾功能亢进12例临床报告

Percutaneous microtraumatic ablation and splenectomy for small liver cancer with severe portal hypertension and hypersplenism （ a report of 12 cases ）

目的评估经皮微创射频消融、无水酒精注射联合脾切除术治疗合并重度门静脉高压脾功能亢进的小肝癌的疗效和安全性。方法对我院收治的12例小肝癌合并门静脉高压，脾功能亢进的患者的临床资料进行回顾性分析，积极术前准备，行脾切除、门奇静脉断流术的同时行肿瘤射频消融、无水酒精注射治疗，术后随访肝功能、血常规、甲胎蛋白等。结果除1例脾切除术后出现胰漏，继发感染，给予抗生素冲洗、置管引流后恢复，所有患者行脾切除及微创治疗后无严重并发症，术后18～30d出院。结论对于重度肝硬化、门静脉高压合并脾功能亢进的小肝癌患者，行脾切除、门奇静脉断流术的同时行射频消融及无水酒精沣射治疗．早一种寄伞可行的治疗方洪。

Objective To evaluate the efficacy and safiy of percutaneons microtrauma ablation in combination with spleneetomy in the treatment of small liver cancer aeeompanied with severe portal hypertension and hypersplenism. Methods Clinical data of 12 patients who were diagnosed as having small liver cancer with portal hypertension and hypersplenism and underwent surgical treatment from January 2005 to December 2009 in our hospital were retrospectively analyzed. These patients were given splenoetomy and （or） portal azygous disconnection. Meanwhile, radiofrequency ablation and percutaneous ethanol injection therapy were performed. The liver function, blood routine, CT scan and AFP level were monitored during the follow - up. Results One patient developed postoperative pancreatic leakage and seeondary infection, and was cured after antibiotics therapy and tube drainage. The others were discharged 18 to 30 days after the operation with no complications. Conclusion Splenoctomy and （or） portal azygous disconnection in combination with percutaneous ablation is a safe and feasible method for the treatment of small liver cancer with severe portal hypertension and hypersplenism.