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.pdf

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1、中华临床医师杂志r电子版)2013年l1月第7卷第22期Chi1lJCliniciansfElectronicEdition)．November15．2013．Vo1．7．No．22·临床论著·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史丈高陈翔陈昌浩【摘要】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

2、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。‘【关键词

3、】高血压，门静脉；脾动脉结扎；胃左血管离断；肝切除术TheclinicalvalueofsplenicarteryligationcombinedwithleftgastricvasculardisconnectioninthetreatmentofprimaryhepatoceHularcarcinomawithportalhypertensionSHIWen-gao，CHENXiang,CHENChang-hao．DepartmentofGeneralSurgery,theTumorHospitalofNanjing,Nanjing210003，ChinaCorrespond

4、ingauthor：SHIWen-gao，Email：swgzzu@163．com[Abstract]0bjectiveToinvestigatetheclinicalvalueofspleenarteryligationcombinedwithleftgastricvasculardisconnectioninthetreatmentofhepatocellularcarcinomawithportalhypertension．MethodsSetstheexclusioncriteria,aretrospectiveanalysisof48casesofp1．iInaryhe

5、patocellular,carcinomawithportalhypertension，whichunderwenthepatectomyforhepatocellularcarcinomain26cases(hepatectomygroup)；hepatectomy，spleenarteryligationcombinedwithleftgastricdisconnectionoperationin22cases(splenicarteryligationgroup)．Comparedtwogroupsofpostoperativeplateletcountingchange

6、，portalveinthrombosis，theincidencerateofHCCrecurrencewimintwoyearsanduppergastrointestinalbleeding．ResultsThetwogroupspreoperativedataandpostoperativecomplicationswerenotstatisticallysignificant；theincidencerateofHCCrecurrencewithintwoyearsinhepatectomygroup(61．5％)wassignificantlyhigherthanth

7、atofthesplenicarteryligationgroup(13．6％)；hepatectomygroupofupperdigestivetracthemorrhage(34．6％1wassignificantlyhigherthanthatofthesplenicarteryligationgroup(9．1％)；thedifferencebetweenthetwoarestatisticalsignificance．Theincidenceofportalveinth