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.