原发性肝癌合并门脉高压症外科治疗体会

Surgical treatment of primary hepatocellular carcinoma associated with portal hypertension

目的总结12例原发性肝癌合并门脉高压症患者外科治疗的方法、疗效及经验。方法回顾分析2004年1月～2008年12月在该院同期进行肝癌切除和门脉高压症手术的12例患者的临床资料,观察患者术前和术后1周、1个月的外周血总胆红素、血小板和白细胞的变化,同时观察术后12例患者1、2、3年的生存率。结果 12例患者中行肝癌切除合并单纯脾切除9例,合并脾切除+贲门周围血管断流术3例。术后1周、1个月时血清总胆红素、血小板和白细胞水平与术前比较,差异均有显著性(P<0.05)。出院后患者均随访6个月以上,术后1、2、3年生存率分别为75.0%(9例)、58.3%(7例)和41.6%(5例)。结论掌握好手术指征,加强围手术期肝功能的保护及脾功能亢进的处理,同时采取积极的联合手术治疗是提高此类患者疗效的有效方法。

【Objective】 To summarize the methods,efficacy and experience of surgical treatment for 12 cases of primary hepatocellular carcinoma associated with portal hypertension.【Methods】 Took a retrospective analysis on the clinical data of 12 patients who received liver cancer and portal hypertension surgery in our hospital from January 2004 to December 2008,the blood total bilirubin,platelet and leukocyte changes before and in 1 week,1 month after surgery were observed and the survival rate in 1,2,3 year after surgery were observed.【Results】 9 patients received liver resection combined with single splenectomy,while the other 3 patients received liver resection and splenectomy combined with devascularization of preventriculus peripheral vessels.The serum total bilirubin,platelet and white blood cells in 1 week,1 month after surgery had significantly difference compared with the preoperative level（P 0.05）.After discharge,all patients were followed up for more than 6 months and the 1,2,3 year survival rates were 75.0%（9 cases）,58.3%（7 cases） and 41.6%（5 cases） respectively.【Conclusion】 Master surgical indications,strengthen perioperative liver protection and treatment of hypersplenism and take positive surgical therapy is an effective way to improve the efficacy of these patients.