腹腔镜肝切除联合脾动脉结扎术治疗肝癌合并门脉高压症的疗效分析

Laparoscopic hepatectomy and splenic artery ligation in surgical treatment for cirrhotic patients with hepatocellular carcinoma

目的探讨腹腔镜肝切除联合脾动脉结扎术治疗肝癌合并门脉高压症患者的安全性及有效性。方法2018年2月至2020年2月我院共手术治疗的28例原发性肝细胞肝癌合并肝炎后肝硬化、门脉高压症及脾功能亢进患者,在腹腔镜下先行脾动脉主干结扎、然后再行肝癌的切除,其中局部不规则切除19例、左肝外叶切除9例。回顾性分析患者的一般资料、手术过程、术后恢复及随访结果进行。结果28例手术均获成功,手术平均时间(102±40)min,术中出血量(71.07±79.41)mL,术后平均住院日(6.93±2.90)d。围手术期无死亡病例。术后无脾脓肿及肝衰竭等并发症发生,有5例腹水、2例胸腔积液、1例胆瘘、1例肺炎,均经非手术治疗后好转出院。白细胞及血小板计数术后1周恢复正常,至术后12个月仍维持在正常范围。截至2021年2月,门诊及电话随访12~36月,肝脏肿瘤再发3例次行射频消融治疗,多发肝内外转移死亡1例,上消化道出血死亡1例,失访1例。结论腹腔镜下肝癌切除联合脾动脉结扎术治疗肝功能相对较差的肝癌合并门静脉高压症脾功能亢进患者是安全可行的,且具有微创的优势。

Objective To investigate the feasibility and efficacy of laparoscopic hepatectomy(LH)and splenic artery ligation(SAL)for hepatocellular carcinoma(HCC)with portal hypertension(PH).Methods Clinical data of 28 patients with HCC and PH who underwent surgical treatment in our hospital from February 2018 to February 2020 were analyzed.After laparoscopic staging,all patients started with SAL,followed by locally irregular resection in 19 patients and left lateral segmentectomy in 9 patients.Results All procedure were successfully completed in all the 28 cases with a mean operation time of(102.21±40.33)min,mean blood loss of(71.07±79.41)ml and mean postoperative hospital stay of(6.93±2.90)d.No death and splenic abscess or hepatic failure occurred in postoperative period.The level of white blood celland blood platelet recovered one week after surgery and maintained within normal range one year after surgery.During the 12 to 36 months follow-up,three patients accepted radiofrequency ablation to treat tumor recurrence,one patient died of multiple metastasis,one patient died of upper gastrointestinal hemorrhage,one patient lost to follow-up.Conclusion Laparoscopic hepatectomy with splenic artery ligation showed a feasible method to treat hepatocellular carcinoma combined with portal hypertension,and offered a micro-invasive option for selected patients.