中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
22期
9924-9926
,共3页
高血压,门静脉%脾动脉结扎%胃左血管离断%肝切除术
高血壓,門靜脈%脾動脈結扎%胃左血管離斷%肝切除術
고혈압,문정맥%비동맥결찰%위좌혈관리단%간절제술
Hypertension,portal%Splenic artery ligation%Left gastric vascular disconnection%Hepatectomy
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。
目的：探討脾動脈結扎聯閤胃左血管離斷術對原髮肝癌閤併門靜脈高壓癥治療的臨床治療價值。方法設置排除標準，迴顧分析48例原髮性肝癌閤併門脈高壓癥患者，其中行單純肝癌切除＋胃左血管離斷術26例（肝癌切除組）；行肝癌切除＋胃左血管離斷＋脾動脈結扎術22例（脾動脈結扎組），比較兩組術後血小闆計數變化、門靜脈血栓髮生率，術後兩年內肝癌複髮率及上消化道齣血髮生率。結果術前兩組基本資料及術後併髮癥無統計學意義，單純肝癌切除組兩年腫瘤複髮率（61.5%）明顯高于脾動脈結扎組（13.6%）、單純肝癌切除組上消化道齣血髮生率（34.6%）顯著高于脾動脈結扎組（9.1%），兩者之間差異均有統計學意義。單純肝癌切除組門靜脈血栓髮生率（11.5%）略高于脾動脈結扎組門靜脈血栓髮生率（9.1%），兩者之間差異無統計學意義。結論脾動脈結扎聯閤胃左血管離斷治療閤併門靜脈高壓癥的原髮性肝癌，不增加門靜脈血栓髮生率，且降低腫瘤複髮率及上消化道齣血髮生率；患者長期能否穫益可能還需要進一步的更大量的隨訪研究。
목적：탐토비동맥결찰연합위좌혈관리단술대원발간암합병문정맥고압증치료적림상치료개치。방법설치배제표준，회고분석48례원발성간암합병문맥고압증환자，기중행단순간암절제＋위좌혈관리단술26례（간암절제조）；행간암절제＋위좌혈관리단＋비동맥결찰술22례（비동맥결찰조），비교량조술후혈소판계수변화、문정맥혈전발생솔，술후량년내간암복발솔급상소화도출혈발생솔。결과술전량조기본자료급술후병발증무통계학의의，단순간암절제조량년종류복발솔（61.5%）명현고우비동맥결찰조（13.6%）、단순간암절제조상소화도출혈발생솔（34.6%）현저고우비동맥결찰조（9.1%），량자지간차이균유통계학의의。단순간암절제조문정맥혈전발생솔（11.5%）략고우비동맥결찰조문정맥혈전발생솔（9.1%），량자지간차이무통계학의의。결론비동맥결찰연합위좌혈관리단치료합병문정맥고압증적원발성간암，불증가문정맥혈전발생솔，차강저종류복발솔급상소화도출혈발생솔；환자장기능부획익가능환수요진일보적경대량적수방연구。
Objective To investigate the clinical value of spleen artery ligation combined with left gastric vascular disconnection in the treatment of hepatocellular carcinoma with portal hypertension. Methods Sets the exclusion criteria, a retrospective analysis of 48 cases of primary hepatocellular, carcinoma with portal hypertension, which underwent hepatectomy for hepatocellular carcinoma in 26 cases(hepatectomy group);hepatectomy, spleen artery ligation combined with left gastric disconnection operation in 22 cases(splenic artery ligation group). Compared two groups of postoperative platelet counting change, portal vein thrombosis, the incidence rate of HCC recurrence within two years and upper gastrointestinal bleeding. Results The two groups preoperative data and postoperative complications were not statistically significant; the incidence rate of HCC recurrence within two years in hepatectomy group(61.5%) was significantly higher than that of the splenic artery ligation group(13.6%);hepatectomy group of upper digestive tract hemorrhage(34.6%) was significantly higher than that of the splenic artery ligation group(9.1%);the difference between the two are statistical significance. The incidence of portal vein thrombosis in hepatectomy group(11.5%) is slightly higher than that of splenic artery ligation group(9.1%), difference between the two is not statistically significant. Conclusion The therapy of spleen artery ligation combined with left gastric disconnection in the treatment of primary hepatocellular carcinoma with portal hypertension does not increase the incidence of portal vein thrombosis, and reduce the incidence of tumor recurrence and hemorrhage of upper digestive tract.
