原发性肝癌合并门脉高压症的外科治疗.doc

江苏大学继续教育学院 毕 业 论 文 论文题目: 原发性肝癌合并门脉高压症的外科治疗 专 业: 临床医学06级 姓 名: 马东伟 学 号: 0614911302056 教 学 点: 徐州中大学院 联系方式: 江苏省沛县人民医院外科(221600) 电话:0516手机 原发性肝癌合并门脉高压症的外科治疗 江苏省沛县人民医院外科 马东伟 【摘要】　目的　探讨原发性肝癌合并门脉高压症的一期联合手术治疗的可行性和适应证。方法　回顾性研究15例原发性肝癌合并门脉高压症行手术治疗的病人 ,其中12例附加贲门周围血管离断术加脾切除术;3例行脾切除术。其中13例行不规则肝切除及2例行规则性左半肝切除术。结果　术后均无手术死亡,术后黄疸腹水及消化道出血等并发症在出院时消退,脾亢症状明显缓解。结论　肝癌合并门脉高压症行肝切除或脾切除及断流手术是一种安全可行的方法, 明显减少术后并发症,提高病人远期生存率。　　 【关键词】　原发性肝癌　　门脉高压症　　肝切除术　　脾切除术 　Surgical treatment for primary liver carcinoma with portal hypertension Ma Dongwei Department of Surgery, the People’s Hospital of Pei County, Jiangsu Province 221600 【Abstract】　Objective　To discuss the effect and indication of synchronous hepatectomy and splenectomy for HCC patients with portal hypertension. Methods　 The clinical data of 15 patients with HCC and portal hypertension were analyzed retrospectively. Hepatectomy and splenectomy were performedin 15 patients, including pericardiac devascularizasion in 12 patients. Three patients were treated by splenectomy. Among them 13 patients were treated by irregular hepatectomy and 2 by regular hepatectomy of left half liver. Results　All patients survived. Within serval days of operation, the hypersplenism disappeared, the platelet count were found to be significantly elevated. Conclusions　Synchronous splenectomy can increase the safety of hepatectomy in patients with HCC and reduce the incidence of bleeding complications. Splenectomy also benefits the patient’s forward exist rate. 【Key words】　hepatocellular carcinoma　　portal hypertension　　hepatectomy　　splenectomy 　　 原发性肝癌合并门静脉高压症在临床并不少见，约15~28%的肝癌患者最后死于食管静脉曲张破裂出血，这类患者往往因肝硬变程度较重，常合并脾肿大、脾亢、门静脉高压致食道胃底静脉曲张乃至出血，一旦发生出血，平均生存期仅为83天, 而且这类患者手术后容易发生顽固腹水、肝功能衰竭、消化道出血等严重的并发症，过去曾被列为手术禁忌证,近年来我们开展了肝癌切除联合贲门周围血管离断术加脾切除治疗此类患者，取得了较好的临床疗效, 2年生存率可达66.6%，显示联合手术治疗是提高肝癌合并门静脉高压病人疗效的一种有效手段,可以有效减少远期消化道出血等并发症的发生，提高病人远期生存率。我院自1999到2005年共行肝癌切除联合脾切除及门奇断流手术15例，取得满意疗效。现报告如下: 1　资料和方法 1.1　一般资料