原发性肝癌合并门脉高压患者肝切除术后并发症及其预后临床观察

目的：分析肝切除术治疗原发性肝癌合并门静脉高压患者的临床疗效及并发症。方法：回顾性分析本院肝胆外科收治489例接受肝切除术患者的临床资料，其中68例合并门静脉高压（13.91%），设为观察组，余下421例无合并门静脉高压（86.09%）设为对照组。对两组患者的术后并发症及死亡率、临床基线资料、不同时间段的存活率，并利用Cox回归风险模型进行评价评价影响生存率的因素。结果：（1）术后并发症：观察组20.59%与对照组13.54%（P<0.05）。两组病死亡率比较：术后30d内（P>0.05）；术后90d内（P<0.05）；（2）两组性别、年龄、肿瘤大小、甲胎蛋白水平、肿瘤组织学、切缘等无统计学差异（P>0.05），而总胆红素水平、癌灶数量、Child-Pugh B级例数、白蛋白水平两组差值均具有统计学意义（P<0.05），将有差异的因素运用Cox回归风险模型进行评价后发现，仅有癌灶数量及肿瘤直径是影响肝硬化HCC患者肝切除术后死亡的独立危险因子（P<0.05）；（3）对照组术后第（1、2、5和6）年的生存率分别为91.1%、79.2%、56.21%、41%，而观察组为84.9%、69.3%、48.2%、22.3%，两组比较具统计学差异（P<0.05）。结论：门静脉高压并非原发性肝癌根治切除术的绝对禁忌症，小范围病灶原发性肝癌合并门静脉高压患者可选择相应肝切除术。

Clinical Observation of Complications and Prognosis of Patients with Primary Hepatic Carcinoma Complicated with Portal Hypertension

Objective:To analyze the clinical efficacy and complications of hepatic resection in the treatment of primary hepatic carcinoma with portal hypertension.Methods:The clinical data of 489 patients with liver resection were retrospectively analyzed,including 68 patients with portal hypertension (13.91%), and the remaining 421 patients without combined portal hypertension (86.09%) were set as the control group.The postoperative complications,mortality,clinical baseline data,and survival rate of patients with two groups were evaluated by Cox regression model.Results:(1)Postoperative complications: observation group 20.59% and control group 13.54% (P<0.05).Two groups of patients with disease mortality comparison:after 30d (P>0.05);90d (P<0.05);(2)There was no significant difference in gender,age,tumor size,tumor size,tumor histology,cutting edge,and total bilirubin (P>0.05),total bilirubin level,tumor size,B Child-Pugh level and serum albumin level in two groups. The difference was statistically significant (P<0.05).The number and diameter of tumor were found to be independent risk factors (P<0.05) after hepatectomy for patients with cirrhosis by Cox regression model;(3)The survival rates of the control group 1st,2nd,5th,6th years were 91.1%,79.2%,56.21%,41%,respectively,while the observation group was 84.9%,69.3%,48.2%,22.3%,and the two groups were statistically different (P<0.05).Conclusion:Portal hypertension is not the primary hepatocellular carcinoma radical resection of absolute contraindications, small lesions in primary hepatocellular carcinoma with portal hypertension patients can choose corresponding hepatic resection.