摘要
目的比较肝切除联合脾切除+贲门周围血管离断术与经皮肝穿刺微波治疗联合脾切除+贲门周围血管离断术治疗原发性肝癌合并门脉高压症的术后围手术期并发症发生率及术后存活率,探讨原发性肝癌合并门脉高压症的综合治疗方法。方法回顾性分析山东大学齐鲁医院1992年12月至2008年12月收治的60例原发性肝癌合并门脉高压症病人,其中肝癌切除组34例,肝切除联合脾切除+贲门周围血管离断术;微波治疗组26例,一期先行脾切除+贲门周围血管离断术,术后二期行经皮肝穿刺微波治疗治疗原发性肝癌,对比观察两组病人术后并发症发生率及存活率。结果肝癌切除组术后围手术期,7d内死亡2例,出现严重的心肺并发症1例,腹水5例,胸腔积液2例,门静脉血栓形成3例;微波治疗组术后围手术期无死亡病例,严重心肺并发症1例,腹水1例,胸腔积液1例,门静脉血栓形成1例,肝癌切除组的并发症发生率高于微波治疗组(38.2%比15.4%),但差异无统计学意义(χ2=3.789,P=0.052)。生存分析发现,肝癌切除组术的中位生存时间35个月;微波治疗组为41个月,差异无统计学意义(χ2=0.730,P=0.393)。结论与肝切除联合脾切除+贲门周围血管离断术,先行脾切除+贲门周围血管离断术,后再行经皮肝穿刺微波治疗治疗原发性肝癌合并门脉高压症是可行的。可根据病人的一般状况、肝脏功能、肿瘤的位置、数量及大小选择不同的治疗方法。
Objective To investigate the comprehensive treatment of primary liver cancer complicated with portal hypertension by comparing the incidence of complications and the survival rate of postoperation between percutaneous microwave coagulation therapy combined with splenectomy plus pericardial devascularization and hepatectomy combined with splenectomy plus pericardial devascularization.Methods The medical records of 60 patients who had definite diagnosis of primary liver cancer complicated with portal hypertension from December,1992 to December,2008 were retrospectively reviewed.Of which,34 cases underwent hepatectomy combined with splenectomy plus pericardial devascularization at the same time(hepatectomy group),26 underwent splenectomy plus pericardial devascularization first,then percutaneous microwave coagulation therapy 1~2 weeks later(microwave coagulation therapy group). Incidence of complications and the survival rate postoperatively of the two groups were compared.Results Among the hepatectomy group(n= 34),there were 2 patients died in 7 days after surgery,1 case suffering severe heart and lung complications,ascites in 5 cases,pleural effusion in 2 cases,portal vein thrombosis in 3 cases.And in the percutaneous microwave coagulation therapy group(n= 26),no patients died after surgery,severe heart and lung complications in 1 case,ascites in 1 case,pleural effusion in 1 case,portal vein thrombosis in 1 case.Incidence of complications of the hepatectomy group was higer than that of percutaneous microwave coagulation therapy group(38.2 vs.15.4%),but there was not statistical significance(χ2=3.789,P=0.052).Survival analysis showed that the median survival of hepatectomy group and percutaneous microwave coagulation therapy group was 35 months and 41 months respectively,but not significantly different between the two groups(χ2=0.730,P=0.393).Conclusion Compared with hepatectomy combined with splenectomy plus pericardial devascularization,percutaneous microwave coagulation therapy combined with splenectomy plus pericardial devascularization should be based on general condition of patients,liver function,tumor location number,and size.
出处
《中国实用外科杂志》
CSCD
北大核心
2013年第S1期54-56,共3页
Chinese Journal of Practical Surgery
