肝癌伴门静脉高压症的肝切除术

Hepatic resection for hepatocellular carcinoma with portal hypertension

目的探讨合并门脉高压症的肝癌患者手术切除疗效。方法分析东方肝胆医院1996年至2001年共626例肝癌患者的临床资料,随访终点为2008年9月1日,以死亡作为终点事件。对外科治疗的生存率及预后相关危险因素进行分析。结果合并门脉高压症患者术后1、3、5、10年生存率分别为79.9%、48.7%、37.3%和21.2%,非门脉高压症患者分别为82.7%、54.8%、42.4%和29.7%,两者差异无统计学意义(P>0.05);肿瘤数目>1个、微血管癌栓、肿瘤无包膜或不完整、肿瘤直径>10cm及HBsAg阳性是影响术后生存的独立危险因素。结论门脉高压症并不是肝癌外科手术的禁忌证,对于合并有门脉高压症的肝癌患者,只要肝功能储备良好,肝切除术仍能获得较好的术后生存率。

Objective To elucidate whether the hepateetomy is suitable for HCC with portal hypertension or not. Methods During 1996 to 2001, a total of 626 cases underwent hepatectomy for HCC in Eastern Hepatobiliary Surgery Hospital and their clinical and pathological data, death were collected as the follow-up end in September 1, 2008. The survival rate of surgical treatment and the risk factors impacting on prognosis were analyzed. Results The overall survival rate of 1,3,5,10 year of PHT patients were 79.9＆, 48.7＆, 37.3 % and 21.2 ＆, while that of no-PHT group were 82.7 %, 54.8%, 42.4% and 29.7＆ respectively. There were no significant statistical differences between the two groups （P）0.05）. Tumor number〉1, microvaseular invasion, tumor without or with incomplete eapsule, tumor size：〉 10 cm and HBsAg-positive were independent risk factors for survival. Conclusion Portal hypertension is not a contraindication of hepatectomy for the patients with hepatocellular carcinoma. As long as the patients have good liver function, they can get a better survival rate after hepatectomy.