原发性肝癌合并重度肝硬化的外科治疗(附78例报告)

目的 探讨原发性肝癌合并重度肝硬化外科治疗的方法及疗效。方法 自1993年1月至1999年9月共收治原发性肝癌合并重度肝硬化病人78例。术前以Child分级、ICG及BCAA／AAA评价肝脏功能，重点加强围手术期处理，术中先行脾动脉结扎，再根据肿瘤大小及部位选择手术方案，其中行肝切除术者33例，肝癌冷冻术45例。结果 78例病人术后1，2，3，4，5年生存率分别为91.0%,83.3%,60.3%,34.6%,28.2%。手术并发症为腹水及一过性黄疸。结论 原发性肝癌合并重度肝硬化病人在重视加强围手术期处理的同时行脾动脉结扎，应根据肿瘤大小及部位选择手术方案，可以有效地治疗肿瘤，避免严重的并发症，提高病人的生存质量及延长生存期。

Surgical treatments of primary liver cancer patients with severe cirrhosis: a report of 78 cases CHEN

Objective To discuss the methods and their effects for surgical treatment of primary liver cancer patients with severe cirrhosis. Methods From January 1993 to September 1999, a total of 78 primary liver cancer patients with severe cirrhosis were surgically treated in our hospital. Liver functions were evaluated by Child's classification, ICG and BCAA/AAA preoperatively. In addition, perioperative management was strengthened. During the operation, ligation of splenic artery was performed and then operational approaches selected according to sizes and sites of the tumor (including hepatectomy in 33 patients and cryosurgery in other 45). Results The 1 , 2 , 3 , 4 and 5 year survival rates of these patients were 91 0%, 83 3%, 60 3%, 34 6% and 28 2%, respectively. The operative complications were acites and temporary jaundice. Conclusions For primary liver cancer patients with severe cirrhosis, strengthening of perioperative management, ligation of splenic artery and then selection of operative approaches according to tumor size and site are important for treating the tumor, avoiding severe operative complications, improving patients' life quality and prolonging their survival.