TACE后射频消融联合脾切除加断流术对原发性肝癌合并门静脉高压症的疗效评价

目的:探讨经动脉导管化疗栓塞(TACE)后射频消融联合脾切除加断流术对原发性肝癌合并门静脉高压的疗效。方法:回顾性研究2005年1月—2012年1月46例原发性肝癌合并门静脉高压患者的临床资料,每例肝内病灶数目<3个,病灶直径3～5 cm,合并脾功能亢进、中度以上的食管胃底静脉曲张,且患者因全身状况或肿瘤位置或肝功能情况不能一期手术。全部患者先行TACE治疗,2周后行射频消融联合脾切除加断流术,观察术后并发症发生情况,了解术后血常规、AFP、肝功能变化,复查增强CT了解肿瘤完全缓解率,胃镜评价食管胃底静脉曲张缓解情况,随访观察生存率。结果:本组病例病灶完全缓解率达84.7%,术后患者未出现严重并发症,脾功能亢进纠正,肝功能逐步好转,胃底食管下端静脉曲张明显改善。1、2年存活率分别为82.5%、34.4%。结论:TACE治疗后射频消融联合脾切除加断流术是治疗原发性肝癌合并门静脉高压的安全有效的方法。

Evaluation of combined percutancous radio-frequency ablation and splenectomy plus pericardial devascularization after transcatheter arterial chemoembolization for patients with primary hepatic carcinoma accompanied by portal hypertension

Objective：To evaluate the effects,feasibility and indications of radiofrequency ablation（RFA）and splenectomy in combination with transcatheter arterial chemoembolization（TACE） for patients with primary hepatic carcinoma accompanied by portal hypertension.Methods： The clinical data of 46 patients with hepatic carcinoma accompanied by portal hypertension receiving TACE followed by RFA and splenectomy from January 2005 to January 2012 were retrospectively analyzed.Meanwhile,all the patients were followed up by examinations of liver function,blood RT,AFP,CT and observations of postoperative complications.The tumor necrosis rate and survivaI duration were observed.Results： In the 46 cases during the whole range,all of the combined treatment were completed.No severe complications occurred.Liver function was stable and slowly improved.Small primary hepatic carcinoma was eradicated.The tumor necrosis rate was 84.7%.One-year survival rate 82.5% and two-year survival rate 34.4%.Conclusions： Combined percutancous radio-frequency ablation and hepatectomy in combination with pericardial devascularization after Transcatheter Arterial Chemoembolization is safe and feasible for patients with hepatic carcinoma accompanied by portal hypertensio.