河北医科大学学报

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肝癌切除联合选择性断流术在原发性肝癌合并中重度门静脉高压症中的应用

  

  1. 1.江苏省盐城市第一人民医院普外科,江苏 盐城 224000;2.江苏省盐城市第一人民医院老年医学科,江苏 盐城 224000
  • 出版日期:2016-08-25 发布日期:2016-09-01
  • 作者简介:范仁根( 1974- ),男,江苏盐城人,江苏省盐城市第 一人民医院副主任医师,医学博士,从事外科疾病诊治研究。

The application of hepatectomy conbined with selective devascularization in primary hepatocellular carcinoma complicated with moderate/severe portal hypertension

  1. 1.General surgery, First people's hospital of Yancheng City 224000,China;
    2.General Geriatric Medicine, First people's hospital of Yancheng City 224000, China
  • Online:2016-08-25 Published:2016-09-01

摘要: [摘要] 目的 观察肝癌切除联合选择性断流术在治疗原发性肝癌( primaryhepaticcarcinoma , PHC )合并中
重度门静脉高压症中的临床疗效。方法 回顾性收集行肝癌切除联合选择性断流术的肝癌患者 23 例为观察组,同
时收集行肝癌切除联合门 - 奇静脉断流术的患者 30 例为对照组,收集 2 组患者术后血常规指标如血小板、白细
胞,肝功能指标如丙氨酸转氨酶(
alanineaminotransferase , ALT )、天冬氨酸转氨酶( aspartatetransaminase , AST )、
总胆红素(
totalbilirubin , TB )、白蛋白( albumin , ALB ),术后 2 年内食管胃底出血情况及术后相关并发症情况如肝
性脑病、腹水、应激性溃疡,以及卫生经济学指标如住院时间、住院费用、手术时间等。结果 观察组肝功能相关指
标改善优于对照组( P <0.05 );
2 组术后胃底出血组间、时点间、组间·时点间交互作用差异均有统计学意义( P <
0.05 ); 2 组相关并发症发生率差异无统计学意义( P >0.05 ); 2 组手术时间差异有统计学意义( P <0.05 ), 2 组住院
时间、住院费用差异无统计学意义( P >0.05 )。结论 肝癌切除联合脾切除及选择性门 - 奇静脉断流术能同时处理
肝肿瘤和门静脉高压,显著改善血常规及肝功能等预后指标,有利于降低食管胃底静脉曲张出血的发生。

关键词: 肝肿瘤, 高血压, 门静脉, 治疗结果

Abstract: [
Abstract ] Objective Toinvestigatetheclinicalefficacyofhepatectomyconbined with
selectivedevascularizitioninthetreatmentofprimaryhepaticcarcinoma ( PHC ) complicatedwith
moderate / severeportalhypertension.Methods Clinicaldata of53 patientsof PHC with
moderate / severeportalhypertensionfrom Nov. 2009toNov. 2014wereretrospectivelyananlyzed.
Patientsweredividedintotwogroupsaccordingtothesurgery methods : 23patientsreceived
hepatic-resectionin conbination with splenectomy and selective devascularizition ( observed
group ); 30 patientsreceived hepatic-resectioninconbination withsplenectomyand normal
devascularizition ( controledgroup ) .Clinicalresults werecomparedbetweenthetwogroups.
Results Thewhitebloodcell ( WBC ) andplatelet ( PLT ) wereimprovedafterthesurgeryinboth
groups ( P <0.05 ) andtheimprovementwasbetterintheobservedgroup (
P <0.05 ) .Alltheliver
functionstandardswereimproved ( P <0.05 ) afterthesurgeryinbothgroupsexcepttheALB ,
whiletheimprovementwasbetterintheobservedgroup ( P <0.05 ) .Theaccumulativeincidence
ofhemorrhageofdigestivetractwashigherinthecontroledgroup ( P <0.05 ) .Therewereno significantdifferencesbetweenthetwogroupsregardtothecomplications ( P >0.05 ) andalsothe
medicaleconomicsstandardssuchasthehospitalizationexpensesorlengthofstay ( P >0.05 ),
amongwhichthelengthofsurgeryintheobservedgroupwasexcluded ( P <0.05 ) .Conclusion
Hepatectomyconbinedwithselectivedevascularizationiseffectiveinthemanagementofprimary
hepaticcarcinomacomplicatedwithmoderate / severeportalhypertension.

Key words: liverneoplasms , hypertension, portal , treamentoutcome