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目的:研讨如何选择最佳处理方法,降低死亡率和并发症,提高患者的生存质量,延长生命。方法:对27例原发性肝癌患者采取切除,不能切除者采取局部处理(纯酒精注射、微波固化)加脾动脉结扎。结果:本组27例患者,术后死亡1例,死于肝肾综合征。术后出现如下并发症:腹水(6例),上消化道出血(1 例)、肝肾综合征(1 例),肝创面大出血(1 例)。并发症总发生率33.3％。所有行脾动脉结扎患者,术后血小板均有不同程度提高,无脾梗塞的并发症。随访26例,术后 1年生存率 65.39％(17/26),2年生存率 42.31％(11/26),3年生存率 34.62％(9/26)。结论:原发性肝癌合并严重肝硬化者预后较差。选择适当病例,术前对手术耐受性作充分的估计,术式选用最小肝切除量,对不能行肝癌切除者可对肿瘤作局部处理(纯酒精注射或微波固化等),用脾动脉结扎代替脾切除。加强术后处理和监护可以减少手术死亡率及并发症,提高患者的生存质量,延长生存期。
Objective: To discuss how to choose the best treatment method to reduce mortality and complications, improve the quality of life of patients, and prolong life. Methods: Twenty-seven patients with primary liver cancer were treated with resection. Those who could not be resection were treated with local treatment (pure alcohol injection, microwave curing) and splenic artery ligation. Results: In this group of 27 patients, 1 died after surgery and died of hepatorenal syndrome. The following complications occurred postoperatively: ascites (6 cases), upper gastrointestinal bleeding (1 case), hepatorenal syndrome (1 case), liver hematoma (1 case). The total incidence of complications was 33.3%. All patients undergoing splenic artery ligation had increased postoperative platelet counts and had no complications of splenic infarction. Follow-up was performed in 26 patients. The 1-year survival rate was 65.39% (17/26), the 2-year survival rate was 42.31% (11/26), and the 3-year survival rate was 34.62% (9/26). Conclusion: The prognosis of primary liver cancer with severe cirrhosis is poor. Selection of appropriate cases, preoperative evaluation of surgical tolerance, surgical selection of the smallest amount of hepatectomy, can not be performed on liver cancer resection of the tumor can be treated locally (pure alcohol injection or microwave curing, etc.), with splenic artery ligation Instead of splenectomy. Strengthening postoperative management and monitoring can reduce operative mortality and complications, improve the quality of life of patients, and prolong survival.