中华普通外科学文献（电子版）
中華普通外科學文獻（電子版）
중화보통외과학문헌（전자판）
CHINESE JOURNAL OF GENERAL SURGERY(ELECTRONIC VERSION)
2013年
2期
110-113
,共4页
黎东明%汪谦%胡文杰%阿力亚%梁力建
黎東明%汪謙%鬍文傑%阿力亞%樑力建
려동명%왕겸%호문걸%아력아%량력건
原发性肝癌%脾功能亢进%肝切除术%脾切除术%个体化治疗
原髮性肝癌%脾功能亢進%肝切除術%脾切除術%箇體化治療
원발성간암%비공능항진%간절제술%비절제술%개체화치료
Primary liver cancer%Hypersplenism%Hepatectomy%Splenectomy%Individualized treatment
目的探讨肝癌合并门静脉高压脾功能亢进（脾亢）的外科个体化治疗措施。方法回顾性分析中山大学附属第一医院肝胆外科2002年1月至2011年12月10年间收治的105例肝癌合并门静脉高压严重脾亢的患者资料，57例行联合肝脾切除（联合组），44例行单纯肝癌切除（肝切组），4例行局部肝癌切除加脾动脉结扎术。结果联合组术后1~2周血小板及白细胞均恢复至正常，联合组与肝切组手术平均出血量分别为（903.62±139.24）ml和（802.56±146.52）ml（t =3.535，P <0.01），差异有统计学意义，两组并发症分别为14例和15例，差异无统计学意义（χ2=1.102，P >0.05），两组围手术期死亡各2例。结论联合肝脾切除治疗肝癌合并门静脉高压脾亢可作为首选，只要掌握好适应证，做好围手术期处理，手术是安全的，建立个体化治疗措施是降低术后并发症和死亡率，提高疗效的关键。
目的探討肝癌閤併門靜脈高壓脾功能亢進（脾亢）的外科箇體化治療措施。方法迴顧性分析中山大學附屬第一醫院肝膽外科2002年1月至2011年12月10年間收治的105例肝癌閤併門靜脈高壓嚴重脾亢的患者資料，57例行聯閤肝脾切除（聯閤組），44例行單純肝癌切除（肝切組），4例行跼部肝癌切除加脾動脈結扎術。結果聯閤組術後1~2週血小闆及白細胞均恢複至正常，聯閤組與肝切組手術平均齣血量分彆為（903.62±139.24）ml和（802.56±146.52）ml（t =3.535，P <0.01），差異有統計學意義，兩組併髮癥分彆為14例和15例，差異無統計學意義（χ2=1.102，P >0.05），兩組圍手術期死亡各2例。結論聯閤肝脾切除治療肝癌閤併門靜脈高壓脾亢可作為首選，隻要掌握好適應證，做好圍手術期處理，手術是安全的，建立箇體化治療措施是降低術後併髮癥和死亡率，提高療效的關鍵。
목적탐토간암합병문정맥고압비공능항진（비항）적외과개체화치료조시。방법회고성분석중산대학부속제일의원간담외과2002년1월지2011년12월10년간수치적105례간암합병문정맥고압엄중비항적환자자료，57례행연합간비절제（연합조），44례행단순간암절제（간절조），4례행국부간암절제가비동맥결찰술。결과연합조술후1~2주혈소판급백세포균회복지정상，연합조여간절조수술평균출혈량분별위（903.62±139.24）ml화（802.56±146.52）ml（t =3.535，P <0.01），차이유통계학의의，량조병발증분별위14례화15례，차이무통계학의의（χ2=1.102，P >0.05），량조위수술기사망각2례。결론연합간비절제치료간암합병문정맥고압비항가작위수선，지요장악호괄응증，주호위수술기처리，수술시안전적，건립개체화치료조시시강저술후병발증화사망솔，제고료효적관건。
Objective To investigate the surgical individualized treatment for Primary liver cancer(PLC) with portal hypertension and hypersplenism. Methods One hundred and five PLC cases with portal hypertension and hypersplenism admitted in the hepatobiliary department of first affiliated hospital of SYSU at recent decade between January 2002 and December 2011 were studied respectively, fifty-seven cases received synchronous hepatectomy and splenectomy(combined group), 44 cases for hepatectomy only(hepatectomy group), 4 cases for hepatectomy and spleen artery ligation. Results The platelet and white blood cell counts in combined group recovered to normal in 1-2 weeks. Average blood loss(ml) in combined group versus hepatectomy group were 903.62±139.24 vs 802.56±146.52,t =3.535,P <0.01.Complication incidence cases were 14 vs15 respectively,χ2=1.102, P >0.05. Each groups had two deaths during the peri-operative period. Conclusions Synchronous hepatectomy and splenectomy should be consider a choice of operation for PLC accompanied portal hypertension and hypersplenism. It may be safe with indication properly chosen and well treatment during the peri-operative period. The critical point is to establish the surgical individualized treatment for reducing the complication rate and mortality, so as to improve the effective treatments.
