肝脾联合切除和胃左血管离断术治疗肝癌合并门脉高压症的临床意义

Role of united hepatectomy and splenctomy and ligation of the left gastric vein in the surgical treatment of hepatocellular carcinoma complicated with portal hypertension

目的探讨原发性肝癌合并门脉高压患者行肝脾联合切除、胃左血管离断的临床意义。方法回顾分析26例原发性肝癌合并门脉高压症患者,其中行肝脾联合切除、胃左血管离断术14例(联合切除组),行单存肝癌切除12例(肝癌切除组),比较两组的术后并发症、血常规变化,术后2年肿瘤的复发率、死亡率及上消化道出血率。结果术前两组之间基本资料及术后并发症无统计学意义,联合切除组两年肿瘤复发率及上消化道出血率明显低于单独切除组;两组肿瘤复发率分别为14.3%和58.3%,上消化道出血率分别为7.14%和41.7%,两者之间差异有统计学意义;各组的两年死亡率分别为14.3%和41.7%,两者之间差异无统计学意义。结论肝癌切除联合脾脏切除、胃左血管离断术,该手术是安全的,可有效降低上消化道出血的发生率和肿瘤复发率。

Objective To investigate the clinical significance of unitedhepatectomy and splenctomy and ligation of the left gastric vein in the treatment of hepatocellular carcinoma complicated with portal hypertension.Methods Twenty-six patients of primary liver cancer with hypertension of portal vein were retrospectively analyzed.They were divided into two groups,namely the group of combined resection of hepatocellular carcinoma and spleen and ligation of the left gastric vein(combined resection group n=14) and the group of hepatectomy only(isolated resection group n=12).The changes of blood routine,the complications of the surgical,2-year morbidity,the tumor recurrence rate,the incidence rate of upper gastrointestinal bleeding were compared between the two groups.Results The basic knowledge and the operation complications between the two groups were not significantly different.There was no significant difference of 2-year morbidity between the two groups(14.3%VS41.7%;P=0.117>0.05),but the 2-year tumor recurrence rate,the incidence rate of upper gastrointestinal bleeding of the combined resection group was lower than that of isolated resection group.(14.3% VS 58.3%;7.14% VS 41.7% respectively).The differences was significant(P<0.05).Conclusion The surgical of united hepatectomy and splenctomy and ligation of the left gastric vein is safe,and can effectively decrease the incidence rate of upper gastrointestinal bleeding and the recurrence rate of carcinoma.