肝癌并门静脉高压症的一期外科治疗(附17例报告)

Surgical Treatment for Hepatocellular Carcinoma with Concomitant Portal Hypertension(A Report of 17 Cases).

目的 :探讨肝癌合并门静脉高压症一期外科治疗的指征与方法。方法 :回顾分析 1 992～ 1 998年经手术治疗的 1 7例肝癌合并门静脉高压症病人 ,在切除肝癌病灶的同时行脾切除加门奇断流术 9例 ;脾切除术 8例 ,其中 2例于术前2周先行食管曲张静脉套扎 2～ 3次。结果 :术后 7d死亡 1例 ,严重心肺并发症及多量腹水各 1例。术后 1、2、3年生存率分别为 94%、53 %、44 %。死亡原因依次是肝癌复发、肝功能衰竭、上消化道出血。结论 :肝癌合并门静脉高压症一期手术治疗是安全可行的 。

To investigate the indication of surgical treatment for hepatocellular carcinoma with concomitant portal hypertension. Methods: Seveteen cases of hepatocellular carcinoma(HCC) with concomitant portal hypertension submitted to surgical treatment were analyzed retrospectively. Liver cancers were all resected and in 9 cases, portal hypertension was concurrenly treated by splenectomy plus portoazygous devascularization; Only splenectomy was performed in 8 cases; and in 2 of the 8 cases, endoscopic esophageal varices ligation was done 2～3 times before 2 weeks of operation. Results: The 1, 2 and 3 year survival cases was 15(93.75%), 8(50.00%) and 7(43.75%) respectively. The causes of death were cancer recurrence, liver failure and upper gastrointestinal hemorrhage. Conclusions: Partial liver resection for small HCC and treatment of portal hypertension could be carried out concomitantly in selected cases.