中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (05): 409-412.

• 论著 • 上一篇    下一篇

同期联合手术治疗原发性肝癌伴严重门静脉高压症疗效评价

单成祥1 ，杨 宁2 ，杨广顺2   

  1. 1第二军医大学长征医院微创外科，上海 200003；2第二军医大学东方肝胆外科医院胆道二科，上海 200438
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-05-13 发布日期:2009-05-13

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-05-13 Published:2009-05-13

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摘要：

目的 探讨同期联合手术（肝癌根治性切除术联合脾切除术、门奇静脉断流术）治疗原发性肝细胞癌伴门静脉高压症病人的安全性和有效性。 方法 将1999年4月至2004年4月第二军医大学东方肝胆外科医院单一手术组收治的116例原发性肝细胞癌伴或不伴门静脉高压症病人分为3组，病例组（联合手术组）为肝癌伴严重门静脉高压症行联合手术的病人，对照Ⅰ组为肝癌伴轻度门静脉高压症行肝癌切除术的病人，对照Ⅱ组为肝癌不伴门静脉高压症行肝癌切除术的病人。对比各组临床资料及远期随访结果。 结果 联合手术组病人的平均住院费用及住院时间高于两组对照组；116例病人仅对照Ⅰ组的1例术前肝功能能评分为Child C级病人发生围手术期死亡；联合手术组术后腹水发生率高于两组对照组；但术后白细胞、血小板升高较两组对照组明显。3年随访中116例病人共死亡63例，联合手术组远期出血率明显低于对照Ⅰ组；Kaplan-Meier生存分析提示联合手术组与对照Ⅱ组的远期生存相仿，而无论是联合手术组还是对照Ⅱ组的远期生存都优于对照Ⅰ组。 结论 同期联合手术是治疗原发性肝癌伴严重门静脉高压症病人（肝功能能评分Child A或B级）的安全有效手段；如果对伴轻度门静脉高压的肝癌病人仅行肝切除术，其术后出血率较高，远期生存较差，故对此类肝癌病人亦应重视门静脉高压症的治疗。

关键词: 原发性肝细胞癌, 门静脉高压症, 脾切除术, 门奇静脉断流术, 肝切除术

Abstract:

Combined surgery for patients with primary hepatocellular carcinoma complicated with severe portal hypertension SHAN Cheng-xiang*，YANG Ning，YANG Guang-shun . *Department of Minimally Invasive Surgery, Chang Zheng Hospital, the Second Military Medical University, Shanghai200003, China Corresponding author：YANG Ning，E-mail： yangning00@citiz.net Abstract Objective To evaluate the safety and efficacy of the combined surgery comparing with single hepatectomy for primary hepatocellular carcinoma（HCC）complicated portal hypertension(PHT). Methods The clinical data of 116 cases of HCC with or without PHT admitted from April 1999 to April 2004 at the Eastern Hepatobiliary Surgery Hospital of Second Military Medical University were analyzed. All the cases were divided into 3 groups.The case group included the cases performed combined operations. The control groupⅠand Ⅱincluded the cases performed single hepatectomy. Results The average admission fee of the case group was more expensive and the average admission length was longer than that of both control groups. During the perioperative period, all the cases encountered no death with the exception of one case ranking Child C in control groupⅠ. The incidence of ascites and the counting of WBC and PLT in the blood samples were higher in the case group after surgeries. By the end of the follow-up of 3 years, total 63 cases died. The postoperative 1, 2, and 3-year hemorrhagic rates of the case group were lower than that of control groupⅠ．In the Kaplan－Meier analysis, it found that there was no statistical significance in the long time survival between the case group and the control group Ⅱ. However, both the above survival rates were more encouraging than the control groupⅠ. Conclusion Hepatectomy combined with portaazygous devascularization and splenectomy are safe and feasible for the cases (Child-Pugh ranking A and B) of HCC complicated with severe PHT. Only single hepatectomy for the HCC complicated with mild PHT would lead to a higher hemorrhagic rate and lower survival rate which suggesting that combined surgeries should also be applied for the cases.

Key words: primary hepatocellular carcinoma, portal hypertension, splenectomy, portal azygous disconnection, hepatectomy