CAJ | 학술논문

目的:探讨肝癌合并中重度门静脉高压症外科常规手术方式对患者预后的影响.方法:回顾分析1996.6~2010.4在我院经外科常规手术治疗的93例肝癌合并中重度门静脉高压症病例,其中肝癌行不规则切除59例,行射频热毁损术59例;门脉高压行贲门周围血管离断加脾切除术41例,行脾切除术加胃冠状静脉结扎术30例,行脾动脉结扎术22例.结果:随访2月~3年,肝部分切除同时行脾动脉结扎、脾切除、门奇静脉断流术围手术期发生肝衰竭死亡1例;开腹肝癌射频消融治疗同时行脾动脉结扎、脾切除、门奇静脉断流术无严重并发症发生.肝癌切除组常规手术后1、2、3年生存率分别为95.6%、66.3%、52.9%,死亡原因依次是肝癌复发、肝功能衰竭、上消化道出血;肝癌射频消融组常规手术后1、2、3年生存率分别为96.1%、67.1%、50.3%,死亡原因同肝癌切除组.结论:术前病情不同,行外科切除与射频消融相比,两种治疗措施的疗效没有差异性,个体化治疗是肝癌合并门静脉高压症治疗的关键.肝脏移植是肝癌合并门静脉高压症最佳治疗手段.如适应症选择得当,肝癌和门静脉高压症同时手术治疗是安全可行的.
목적:탐토간암합병중중도문정맥고압증외과상규수술방식대환자예후적영향.방법:회고분석1996.6~2010.4재아원경외과상규수술치료적93례간암합병중중도문정맥고압증병례,기중간암행불규칙절제59례,행사빈열훼손술59례;문맥고압행분문주위혈관리단가비절제술41례,행비절제술가위관상정맥결찰술30례,행비동맥결찰술22례.결과:수방2월~3년,간부분절제동시행비동맥결찰、비절제、문기정맥단류술위수술기발생간쇠갈사망1례;개복간암사빈소융치료동시행비동맥결찰、비절제、문기정맥단류술무엄중병발증발생.간암절제조상규수술후1、2、3년생존솔분별위95.6%、66.3%、52.9%,사망원인의차시간암복발、간공능쇠갈、상소화도출혈;간암사빈소융조상규수술후1、2、3년생존솔분별위96.1%、67.1%、50.3%,사망원인동간암절제조.결론:술전병정불동,행외과절제여사빈소융상비,량충치료조시적료효몰유차이성,개체화치료시간암합병문정맥고압증치료적관건.간장이식시간암합병문정맥고압증최가치료수단.여괄응증선택득당,간암화문정맥고압증동시수술치료시안전가행적.
Objective:Severe the door explore hepatocellular carcinoma with portal hypertension surgery routine surgical procedure on the prognosis of patients.Methods:A retrospective analysis of the the 1996.6~2010.4 hospital surgical conventional surgical treatment of 93 cases of hepatocellular carcinoma with severe portal hypertension in cases of liver cancer line irregular resection in 59 cases, radiofrequency thermal ablation, 59 cases;portal hypertension OK pericardial blood vessel off plus splenectomy was performed in 41 cases, splenectomy plus 30 cases of gastric coronary vein ligation, OK splenic artery ligation was performed in 22 cases.Results:All cases were followed up for 3 years in February, partial hepatectomy and spleen artery ligation, splenectomy, door azygos disconnection perioperative liver failure and 1 died;open radiofrequency ablation for the treatment simultaneously splenic artery ligation. splenectomy door azygos disconnection No serious complications occurred. 1-, 2- and 3-year survival rate after conventional surgery of the liver resection group were 95.6%, 66.3%, 52.9%, the causes of death were recurrence of liver cancer, liver failure, upper gastrointestinal bleeding;radiofrequency ablation group, conventional surgery after 1, 2, 3-year survival rates were 96.1%, 67.1%, 50.3%, the cause of death in the hepatectomy group.Conclusion:Preoperative condition different underwent surgical resection and radiofrequency ablation compared, no difference in the efficacy of two treatment measures, individualized treatment is the key to the treatment of hepatocellular carcinoma with portal hypertension. Liver transplantation is the best treatment of hepatocellular carcinoma with portal hypertension. The right choices, such as indications, liver and portal hypertension surgery is safe and feasible