肝癌合并中重度门静脉高压症外科治疗决策的风险因素分析

目的:探讨肝细胞肝癌(HCC)合并中重度门静脉高压症(PHT)手术治疗的安全性和有效性。方法:将2005年1月—2011年12月收治的247例符合相关标准的HCC-PHT患者分为单纯肝癌切除组(不伴门静脉高压或伴中、轻度门静脉高压)和肝切除联合门奇静脉断流组,进行实验室指标和术后肝性脑病、腹水、胃溃疡、再出血等风险因素对比分析。结果:联合手术组患者术后肝功能恢复、肝性脑病、腹水、胃溃疡、再出血等并发症的发生率与单纯手术组无统计学差异(P>0.05),但术后白细胞及血小板明显升高,远期出血率明显降低(均P<0.05)。结论:同期联合手术是治疗原发性肝癌伴有重度门脉高压症患者的安全有效的治疗方法,可改善患者生活质量,且并不增加手术的病死率及术后并发症的发生率。

Risk factors analysis for surgical treatment decision-making of hepatocellular carcinoma associated with moderate/severe portal hypertension

Objective: To investigate the safety and efficacy of surgical treatment in hepatocellular carcinoma(HCC) combined with moderate/severe portal hypertension(PHT). Methods: From January 2005 to December 2011,247 patients with HCC-PHT who met the criteria were designated to undergo simple hepatectomy(none,mild or moderate PHT) or undergo hepatectomy plus azygos-portal disconnection.The laboratory parameters and postoperative risk factors such as hepatic encephalopathy,ascites,gastric ulcer and recurrent bleeding between the two groups were compared and analyzed. Results: Compared with the simple hepatectomy group,the postoperative liver function recovery and the incidence of hepatic encephalopathy,ascites,gastric ulcer and recurrent bleeding in the combination surgery group showed no significant difference(all P>0.05),but the postoperative white blood cell(WBC) and platelet counts significantly increased,and the long-term risk of recurrent bleeding significantly decreased in the combination surgery group(all P<0.05). Conclusion: The synchronous operation is a safe and effective method for treatment of HCC with severe PHT.It can improve the quality of life in this subset of patients but does not increase the surgical mortality and postoperative complications.