肝癌合并门静脉高压症的联合手术治疗

目的：探讨肝癌合并门静脉高压症联合手术治疗的可行性、适应证和手术方式。方法：回顾分析我科1995年1月－2002年1月联合手术治疗肝癌合并静脉高压症45例（其中3例为肝癌术后肝内复发合并门静脉高压症患者）的疗效。结果：无手术死亡。术后1／2、1、2、3、4、5、6、7年绝对生存率分别为44／45（97．8％）、30／41（73．2％）、26／36（72．2％）、13／27（48．1％）、10／19（52．6％）、5／13（38．5％）、1／7（14．3％）、0／2（0）。住院期间发生顽固性腹水、肝肾综合征各1例。随访中共死亡14例，发生上消化道大出血2例，死亡原因；肝癌复发9例，肝功能衰竭4例，上消化道大出血1例。结论：有选择性地对肝癌合并门静脉高压症患者行联合手术治疗是安全可行的，肝癌切除联合行脾切除或／和加门奇断流术效果好。

Combined operations for patients with hepatic cancer complicated by portal hypertension]

OBJECTIVE: To study the feasibility and operative procedures of liver resection in combination with collateral devascularization for treating patients with hepatic cancer complicated by portal hypertension. METHODS: A retrospective analysis was conducted in 45 cases of hepatectomy for hepatic cancer in combination with portaazygous devascularization for portal hypertension from Jan. 1995 to Jan. 2002. RESULTS: Operative mortality was zero. The absolute survival rate in 1/2, 1, 2, 3, 4, 5, 6, and 7 years was 44/45(97.8%), 30/41(73.2%), 26/36 (72.2%), 13/27(48.1%), 10/19(52.6%), 5/13(38.5%), 1/7(14.3%), 0/2(0) respectively. During hospitalization, refractory ascites occurred in 1 case and hepatorenal syndrome in another. Upper gastrointestinal hemorrhage occurred in 2 cases during the follow-up period. In the 14 patients who died during the follow-up, 9 died of cancer recurrence, 4 of liver function failure, and 1 of upper gastrointestinal hemorrhage. CONCLUSION: Hepatectomy in combination with portaazygous devascularization for patients with liver cancer complicated by portal hypertension is safe and feasible.