脾动脉结扎联合胃左血管离断术对原发肝癌合并门脉高压症治疗的临床价值

目的：探讨脾动脉结扎联合胃左血管离断术对原发肝癌合并门静脉高压症治疗的临床治疗价值。方法设置排除标准，回顾分析48例原发性肝癌合并门脉高压症患者，其中行单纯肝癌切除＋胃左血管离断术26例（肝癌切除组）；行肝癌切除＋胃左血管离断＋脾动脉结扎术22例（脾动脉结扎组），比较两组术后血小板计数变化、门静脉血栓发生率，术后两年内肝癌复发率及上消化道出血发生率。结果术前两组基本资料及术后并发症无统计学意义，单纯肝癌切除组两年肿瘤复发率（61.5%）明显高于脾动脉结扎组（13.6%）、单纯肝癌切除组上消化道出血发生率（34.6%）显著高于脾动脉结扎组（9.1%），两者之间差异均有统计学意义。单纯肝癌切除组门静脉血栓发生率（11.5%）略高于脾动脉结扎组门静脉血栓发生率（9.1%），两者之间差异无统计学意义。结论脾动脉结扎联合胃左血管离断治疗合并门静脉高压症的原发性肝癌，不增加门静脉血栓发生率，且降低肿瘤复发率及上消化道出血发生率；患者长期能否获益可能还需要进一步的更大量的随访研究。

The clinical value of splenic artery ligation combined with left gastric vascular disconnection in the treatment of primary hepatocellular carcinoma with portal hypertension

Objective To investigate the clinical value of spleen artery ligation combined with left gastric vascular disconnection in the treatment of hepatocellular carcinoma with portal hypertension. Methods Sets the exclusion criteria, a retrospective analysis of 48 cases of primary hepatocellular, carcinoma with portal hypertension, which underwent hepatectomy for hepatocellular carcinoma in 26 cases（hepatectomy group）;hepatectomy, spleen artery ligation combined with left gastric disconnection operation in 22 cases（splenic artery ligation group）. Compared two groups of postoperative platelet counting change, portal vein thrombosis, the incidence rate of HCC recurrence within two years and upper gastrointestinal bleeding. Results The two groups preoperative data and postoperative complications were not statistically significant; the incidence rate of HCC recurrence within two years in hepatectomy group（61.5%） was significantly higher than that of the splenic artery ligation group（13.6%）;hepatectomy group of upper digestive tract hemorrhage（34.6%） was significantly higher than that of the splenic artery ligation group（9.1%）;the difference between the two are statistical significance. The incidence of portal vein thrombosis in hepatectomy group（11.5%） is slightly higher than that of splenic artery ligation group（9.1%）, difference between the two is not statistically significant. Conclusion The therapy of spleen artery ligation combined with left gastric disconnection in the treatment of primary hepatocellular carcinoma with portal hypertension does not increase the incidence of portal vein thrombosis, and reduce the incidence of tumor recurrence and hemorrhage of upper digestive tract.