脾切除贲门周围血管离断术在老年原发性肝癌相关门静脉高压治疗中的应用
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摘要
目的探讨脾切除贲门周围血管离断术在老年原发性肝癌相关门静脉高压治疗中的应用效果。方法回顾性分析2013年6月至2015年6月76例老年原发性肝癌相关门静脉高压患者的临床资料。根据是否行同期脾切除贲门周围血管离断术分为对照组(单纯行肝切除手术,37例)和观察组(同期肝切除联合脾切除贲门周围血管离断术,39例)。所有数据均采用SPSS 20. 0统计软件进行分析,术中术后相关指标以(x珋±s)表示,进行独立t检验;术后并发症发生率及术后1、2、3年生存率采用χ2检验,P <0. 05差异具有统计学意义。结果观察组手术时间较对照组显著延长,出血量显著增多,术后感染发生率、消化道出血发生率及总并发症发生率均显著降低,差异均具有统计学意义(P <0. 05)。两组术后肠功能恢复时间、首次进食、引流管拔出、住院时间相比,差异均无统计学意义(P> 0. 05)。两组患者术后ALB水平较术前均显著升高,ALT、TBIL水平均显著降低,且观察组显著优于对照组,差异均具有统计学意义(P <0. 05)。观察组术后1、2、3年生存率分别为87. 2%、71. 8%、53. 9%,均显著高于对照组(64. 9%、48. 7%、29. 7%),差异均具有统计学意义(P <0. 05)。结论老年原发性肝癌相关门静脉高压症患者行同期肝切除联合脾切除贲门周围血管离断术安全、有效。
Objective To explore the effect of splenectomy and pericardial devascularization in the treatment of elderly primary liver cancer combined with portal hypertension. Methods A retrospective analysis of clinical data of 76 cases of elderly primary liver cancer combined with portal hypertension patients in our hospital from January 2014 to June 2017 was made. According to whether undergoing splenectomy and pericardial devascularization, the patients were divided into the control group( undergoing simple hepatectomy, 37 cases) and the observation group( undergoing splenectomy and pericardial devascularization,39 cases). All data were analyzed by SPSS 20. 0 statistical software. The intraoperative and postoperative related indicators were presented as( x珋± s) and examined by t test. The incidence of postoperative complications and survival rates 1,2,3 years after surgery were compared by chi square test.P < 0. 05 indicated that the difference was statistically significant. Results Compared with the control group,the operative time in the observation group was significantly extended,the intraoperative blood loss significantly was increased,the incidence rate of postoperative infection,gastrointestinal bleeding and totally postoperative complications significantly were decreased,all above had statistical difference( P < 0. 05).There was no statistical difference in the bowel function recovery time, drainage tube pull-out time,hospitalization time between the two groups( P > 0. 05). After surgery,the level of ALB in the two groups were significantly increased,while the levels of ALT and TBIL were significantly decreased,which in the observation group were significantly better than those in the control group,all above had statistical difference( P < 0. 05). The 1-,2-,and 3-year survival rates the observation group( 87. 2%,71. 8%,53. 9%) was respectively higher than the control group( 64. 9%,48. 7%,29. 7%),all above had statistical difference( P < 0. 05). Conclusion Simultaneous hepatectomy combined with splenectomy and pericardial devascularization in the treatment of elderly primary liver cancer combined with portal hypertension is safe and effective.
Objective To explore the effect of splenectomy and pericardial devascularization in the treatment of elderly primary liver cancer combined with portal hypertension. Methods A retrospective analysis of clinical data of 76 cases of elderly primary liver cancer combined with portal hypertension patients in our hospital from January 2014 to June 2017 was made. According to whether undergoing splenectomy and pericardial devascularization, the patients were divided into the control group( undergoing simple hepatectomy, 37 cases) and the observation group( undergoing splenectomy and pericardial devascularization,39 cases). All data were analyzed by SPSS 20. 0 statistical software. The intraoperative and postoperative related indicators were presented as( x珋± s) and examined by t test. The incidence of postoperative complications and survival rates 1,2,3 years after surgery were compared by chi square test.P < 0. 05 indicated that the difference was statistically significant. Results Compared with the control group,the operative time in the observation group was significantly extended,the intraoperative blood loss significantly was increased,the incidence rate of postoperative infection,gastrointestinal bleeding and totally postoperative complications significantly were decreased,all above had statistical difference( P < 0. 05).There was no statistical difference in the bowel function recovery time, drainage tube pull-out time,hospitalization time between the two groups( P > 0. 05). After surgery,the level of ALB in the two groups were significantly increased,while the levels of ALT and TBIL were significantly decreased,which in the observation group were significantly better than those in the control group,all above had statistical difference( P < 0. 05). The 1-,2-,and 3-year survival rates the observation group( 87. 2%,71. 8%,53. 9%) was respectively higher than the control group( 64. 9%,48. 7%,29. 7%),all above had statistical difference( P < 0. 05). Conclusion Simultaneous hepatectomy combined with splenectomy and pericardial devascularization in the treatment of elderly primary liver cancer combined with portal hypertension is safe and effective.
引文
[1]杨镇,万赤丹,邓小荣.腹腔镜门静脉高压症外科治疗发展与新断流术[J/CD].中华普外科手术学杂志(电子版),2017,11(3):181-184.
[2]张焱辉,蒋国庆,唐俊,等.腹腔镜下巨脾切除加贲门周围血管离断术治疗肝硬化门静脉高压的疗效分析[J/CD].中华普外科手术学杂志(电子版),2017,11(5):414-416.
[3] Jiang G,Bai D,Chen P,et al. A Novel Technique for Synchronous Laparoscopic Splenectomy and Azygoportal Disconnection With Hepatectomy[J]. Surg Innov,2018,25(3):218-223.
[4]周益龙,邵冰峰,徐爱兵,等.联合脾脏切除治疗原发性肝癌合并门静脉高压症的临床分析[J].南通大学学报(医学版),2016,36(5):420-424.
[5] Xiao H,Zhang B,Mei B,et al. Hepatic resection for hepatocellular carcinoma in patients with portal hypertension:a long-term benefit compared with transarterial chemoembolization and thermal ablation[J]. Medicine(Baltimore),2015,94(7):e495.
[6]周思佳,罗小平,刘曦,等.肝癌合并肝硬化门静脉高压行TACE联合TIPS治疗的安全性与疗效[J].重庆医学,2017,46(35):4958-4962.
[7]刘庆拿,孟祥涛,李忠超.肝癌切除联合贲门周围血管离断术治疗原发性肝癌并门静脉高压临床观察[J].山东医药,2017,57(36):87-89.
[8]周晶,杨艳芳,张艳洁,等.原发性肝癌TACE治疗后并发上消化道出血的原因及处理[J].医学综述,2018,24(4):698-702.
[9] Serrano OK,Cunha RD,Mettler T,et al. Sinistral Portal Hypertension After Live Segmental Pancreas Donation:A Long-Term Sequelae Presenting With Life-Threatening Upper Gastrointestinal Hemorrhage[J]. Transplant Proc,2017,49(1):221-224.
[10] Han X,Lv Y,Li Y,et al. Distribution characteristics of cells in splenomegaly due to hepatitis B-related cirrhotic portal hypertension and their clinical importance[J]. J Int Med Res,2018,46(7):2633-2640.
[11]洪若丰,黎一鸣,陆宏伟,等.门静脉高压症患者行脾切除术对肝癌发生及复发影响的研究进展[J].中国普外基础与临床杂志,2018,25(1):104-107.
[12]王继才,邰升,乔海泉.腹腔镜微创技术在门脉高压症外科治疗中瓶颈与术式变迁[J/CD].中华普外科手术学杂志(电子版),2017,11(3):185-188.
[13]周益龙,邵冰峰,徐爱兵,等.联合脾脏切除治疗原发性肝癌合并门静脉高压症的临床分析[J].南通大学学报(医学版),2016,36(5):420-424.
[14]陈琳,董为,张必翔,等.肝胆胰外科新理念与新技术[J].科学通报,2017,62(1):36-46.
[2]张焱辉,蒋国庆,唐俊,等.腹腔镜下巨脾切除加贲门周围血管离断术治疗肝硬化门静脉高压的疗效分析[J/CD].中华普外科手术学杂志(电子版),2017,11(5):414-416.
[3] Jiang G,Bai D,Chen P,et al. A Novel Technique for Synchronous Laparoscopic Splenectomy and Azygoportal Disconnection With Hepatectomy[J]. Surg Innov,2018,25(3):218-223.
[4]周益龙,邵冰峰,徐爱兵,等.联合脾脏切除治疗原发性肝癌合并门静脉高压症的临床分析[J].南通大学学报(医学版),2016,36(5):420-424.
[5] Xiao H,Zhang B,Mei B,et al. Hepatic resection for hepatocellular carcinoma in patients with portal hypertension:a long-term benefit compared with transarterial chemoembolization and thermal ablation[J]. Medicine(Baltimore),2015,94(7):e495.
[6]周思佳,罗小平,刘曦,等.肝癌合并肝硬化门静脉高压行TACE联合TIPS治疗的安全性与疗效[J].重庆医学,2017,46(35):4958-4962.
[7]刘庆拿,孟祥涛,李忠超.肝癌切除联合贲门周围血管离断术治疗原发性肝癌并门静脉高压临床观察[J].山东医药,2017,57(36):87-89.
[8]周晶,杨艳芳,张艳洁,等.原发性肝癌TACE治疗后并发上消化道出血的原因及处理[J].医学综述,2018,24(4):698-702.
[9] Serrano OK,Cunha RD,Mettler T,et al. Sinistral Portal Hypertension After Live Segmental Pancreas Donation:A Long-Term Sequelae Presenting With Life-Threatening Upper Gastrointestinal Hemorrhage[J]. Transplant Proc,2017,49(1):221-224.
[10] Han X,Lv Y,Li Y,et al. Distribution characteristics of cells in splenomegaly due to hepatitis B-related cirrhotic portal hypertension and their clinical importance[J]. J Int Med Res,2018,46(7):2633-2640.
[11]洪若丰,黎一鸣,陆宏伟,等.门静脉高压症患者行脾切除术对肝癌发生及复发影响的研究进展[J].中国普外基础与临床杂志,2018,25(1):104-107.
[12]王继才,邰升,乔海泉.腹腔镜微创技术在门脉高压症外科治疗中瓶颈与术式变迁[J/CD].中华普外科手术学杂志(电子版),2017,11(3):185-188.
[13]周益龙,邵冰峰,徐爱兵,等.联合脾脏切除治疗原发性肝癌合并门静脉高压症的临床分析[J].南通大学学报(医学版),2016,36(5):420-424.
[14]陈琳,董为,张必翔,等.肝胆胰外科新理念与新技术[J].科学通报,2017,62(1):36-46.