肝癌合并门静脉高压脾功能亢进105例的外科个体化治疗

Surgical individualized treatment for primary liver cancer with portal hypertension and hypersplenism

目的探讨肝癌合并门静脉高压脾功能亢进(脾亢)的外科个体化治疗措施。方法回顾性分析中山大学附属第一医院肝胆外科2002年1月至2011年12月10年间收治的105例肝癌合并门静脉高压严重脾亢的患者资料,57例行联合肝脾切除(联合组),44例行单纯肝癌切除(肝切组),4例行局部肝癌切除加脾动脉结扎术。结果联合组术后1～2周血小板及白细胞均恢复至正常,联合组与肝切组手术平均出血量分别为(903.62±139.24)ml和(802.56±146.52)ml(t=3.535,P<0.01),差异有统计学意义,两组并发症分别为14例和15例,差异无统计学意义(χ2=1.102,P>0.05),两组围手术期死亡各2例。结论联合肝脾切除治疗肝癌合并门静脉高压脾亢可作为首选,只要掌握好适应证,做好围手术期处理,手术是安全的,建立个体化治疗措施是降低术后并发症和死亡率,提高疗效的关键。

Objective：To investigate the surgical individualized treatment for Primary liver cancer（PLC） with portal hypertension and hypersplenism. Methods：One hundred and five PLC cases with portal hypertension and hypersplenism admitted in the hepatobiliary department of first affiliated hospital of SYSU at recent decade between January 2002 and December 2011 were studied respectively, fifty-seven cases received synchronous hepatectomy and splenectomy（combined group）, 44 cases for hepatectomy only（hepatectomy group）, 4 cases for hepatectomy and spleen artery ligation. Results：The platelet and white blood cell counts in combined group recovered to normal in 1-2 weeks. Average blood loss（ml） in combined group versus hepatectomy group were 903.62±139.24 vs 802.56±146.52, t = 3.535, P 〈 0.01.Complication incidence cases were 14 vs15 respectively, χ2 =1.102, P 〉 0.05. Each groups had two deaths during the peri-operative period. Conclusions：Synchronous hepatectomy and splenectomy should be consider a choice of operation for PLC accompanied portal hypertension and hypersplenism. It may be safe with indication properly chosen and well treatment during the peri-operative period. The critical point is to establish the surgical individualized treatment for reducing the complication rate and mortality, so as to improve the effective treatments.