【摘要】 目的:探讨肝癌切除并脾切断流手术治疗原发性肝癌合并门静脉高压症的疗效以及术中探查不能切除的肝癌患者实施术中射频消融治疗并脾切除和胃冠状静脉结扎的价值。方法:2000年6月—2007年2月228例肝癌合并门静脉高压症患者施行了肝叶切除术(组),其中112例同时行脾切断流术(组)。2001年11月—2007年2月,62例术中探查不能切除的肝癌患者施行术中射频消融治疗(组)其中37例同时行脾切除和胃冠状静脉结扎(组)。结果:,组间手术病死率差异无统计学意义,2.68%vs3.45%(P>0.05)。,组患者食管胃底静脉曲张均获得明显改善。组术后1,2,3年的累积生存率分别为97.2%,88.5%,82.0%,高于组的91.7%,81.8%,74.6%(P<0.05),而5年累积生存率两组分别为53.6%,53.5%,两组间差异无统计学意义(P>0.05)。组术后1年的累积生存率亦明显高于组,87.7%vs62.0%(P<0.05),而2年累积生存率差异无统计学意义,50.2%vs44.7%(P>0.05)。、组死于食管曲张静脉破裂出血的比率分别显著低于、组,5.4%vs35.5%(P<0.01),6.7%vs46.2%(P<0.05)。结论:肝叶切除同时行脾切断流并不增加手术病死率。联合脾切断流或脾切胃冠状静脉结扎可以有效预防患者死于食管曲张静脉破裂出血,有助于提高近期生存率,但无助于提高远期生存率。更多还原

【Abstract】 Objective To investigate the place of united liver resection and spleenectomy, esophageal devascularization and to assess the role of refrequence ablation combined with spleen resection and ligation of gastric coral vein in the surgical treatment of hepatal cellular carcinoma complicated with hepatic cirrhosis and portal hypertension. Methods Two hundred and twenty-eight patients of hepatal cellular carcinoma complicated with liver cirrhosis and portal hypertension were treated by operation. Liver resection and spleenectomy, esophageal devascularization were performed in 112 patients (group Ⅰ), and 116 patients underwent only hepatic lobectomy (group Ⅱ). Radiofrequence ablation interoperation was used to treat 67 patients with unresectable hepatal cellular carcinoma.Among them 37 patients were treated by radiofrequence ablation combined with spleenectomy and ligation of gastric coral vein (group Ⅲ), and the other 25 patients were treated by radiofrequence ablation interoperation only (group Ⅳ). The operative mortality and the 1-, 2-, 3-, 5-year survival rates were compared between group Ⅰ and group Ⅱ. The 1- and 2-year survival rates were compared between group Ⅲ and group Ⅳ. Results The operative mortality of the group Ⅰ and group Ⅱ was 2.68% and 3.45% respectively. There was no statistic difference between the two groups(P>0.05). The 1-, 2-, 3-year survival rates of group Ⅰand group Ⅱ were 97.2%,88.5%,82.0% and 91.7%, 81.8%,and 74.6% respectively. There was a statistic difference between the two groups(P<0.05). The 5-year survival rate had no significant difference between the two groups, respectively(53.6%,53.5%)(P>0.05). The 1-year survival rate of group Ⅲ was higher than that of group Ⅳ( 87.7% vs 62.0%)(P<0.05), and the 2-year survival rate had no significant difference between group Ⅲ and group Ⅳ, respectively(50.2% vs 44.7%)(P>0.05). The mortality rates for esophageal variceal bleeding were lower in group Ⅰ and Ⅲ than those in group Ⅱ and Ⅳ, respectively95.4% vs 35.5%)(P<0.01),(6.7% vs 46.2%)(P<0.05). Conclusion There is no increasing operative mortality for combined resection of hepatocellular carcinoma with spleenecomy, esophageal devascularization, and it improves the 1-, 2-, 3-year survival rates but is not helpful for 5-year survival rate. It promotes the one-year survival rate in patients receiving radiofrequence ablation interoperation in combination with spleenectomy and ligation of gastric coral vein, but the 2-year survival rate is not different from that in those receiving radiofrequence ablation alone. Associated with spleen resection, esophageal devascularition or ligation of gastric coral vein prevents effectively the mortality for esophageal variceal bleeding.更多还原