原发性肝癌合并脾功能亢进的外科治疗

目的 探讨原发性肝癌合并脾功能亢进的合理治疗方法。方法 1994年1月至2004年12月我院收治67例原发性肝癌合并脾功能亢进患者，17例行肝切除联合脾切除，7例行单纯肝切除，43例行肝动脉栓塞化疗联合脾动脉栓塞。结果 肝切除联合脾切除组术后30d患者脾功能亢进症状消失，外周血细胞恢复正常。单纯肝切除组术后脾功能亢进症状加重，其中6例于术后3～7个月分别行脾动脉栓塞治疗。肝动脉栓塞化疗联合脾动脉栓塞组治疗后30 d 79％（34／43）的病例脾功能亢进症状改善，外周血细胞恢复正常。结论 原发性肝癌合并脾功能亢进的处理应争取行肝切除联合脾切除治疗，如肝癌不能切除，则应争取行肝动脉栓塞化疗联合脾动脉栓塞治疗。

Surgical Treatment for Primary Hepatocellular Carcinoma Associated with Hypersplenism

Objective To explore the appropriate surgical management of the primary hepatocellular carcinoma with hypersplenism. Methods Of 67 patients who has primary hepatocellular carcinoma with hypersplenism,17 cases had hepatectomy combined with splenectomy,7 cases had hepatectomy only,and the other 43 patients were treated with hepatic artery embolization and splenic artery embolization.Results The symptoms of hypersplenism disappeared and the hemogram became normal 30 d after operation in 17 patients who had hepatectomy combined with splenectomy,but worsened in 7 patients who only had simple hepatectomy and 6 cases of those patients were treated with splenic artery embolization 3-7 months after operation.In 43 patients treated with hepatic artery embolization and splenic artery embolization,79%(34/43)had improved hypersplenism symptoms and the hemogram became normal.Conclusion The treatment of primary hepatocellular carcinoma with hypersplenism should be strived for hepatectomy combined with splenectomy.If the liver mass cannot be resected,hepatic artery embolization and splenic artery embolization should be chosen.