| ObjectiveTo compare the clinical efficacy of Synchronous hepatectomy and Splenectomy with periesophagogastric devascularization and Hepatectomy alone for the treatment of Hepatocellular carcinoma with liver cirrhosis,portal hypertension and upper gastrointestinal bleeding.MethodsThe clinical data of patients with Hepatocellular carcinoma with liver cirrhosis,portal hypertension and upper gastrointestinal bleeding who first visited the First Affiliated Hospital of Zhengzhou University from January 2008 to December 2012 were retrospectively analyzed.The patients were divided into Synchronous hepatectomy and Splenectomy with periesophagogastric devascularization(observed group)and Hepatectomy alone group(control group)according to the surgical method.The observed group consisted of 42 patients,including 32 males and 10 females,with an average age of(51.3±7.5)years.The control group consisted of 40 patients,including 32 males and 8 females,with an average age of(52.4±8.0)years.The relative indicators of platelet,leukocyte,total bilirubin,postoperative complications,tumor-free survival,and overall survival were compared between the two groups.ResultsAfter operation,the WBC and PLT count of the observed group were significantly increased after 2-3 days,which gradually decreased after 7 to 10 days and they were basically within the normal range,and higher than the preoperative level.The WBC and PLT skills of the patients in the control group showed a transient increase after surgery,and they gradually decreased after 7 days after surgery,which was basically the same as the preoperative level.The WBC and PLT of the observed group were significantly higher than that of the control group on the 14 th day after operation(P<0.05),and the bilirubin level in the observed group was significantly lower than that in the control group at the same time.The recent postoperative complications of two groups were not statistically different.The incidence of portal venous thrombosis in patients of observed group in the long-term complications(11.9%)was significantly higher than that in patients of control group(2.5%),with statistical significance(P<0.05);The rate(4.8%)of upper gastrointestinal rebleeding rate was significantly lower than that of(27.5%)control group with statistical significance(P<0.05).The average survival time of observed group and control group was 47.18±10.90 months and 38.61±10.05 months,respectively.The median overall survival time was 49.0 months and 41.0 months,respectively.The mean time for tumor-free survival of the observed group and control group was 33.83±9.34 months and 28.78±9.98 months respectively,and the median time to no tumor was 37.5 months and 30.0 months,respectively.The tumor-free survival rates of patients in the observed group were 78.5%,59.5%,and 29.5% in the 1-,3-,and 5-years,respectively,and the tumor-free survival rates in the control group were 65.2%,48.6%,and 1 year,3 years,and 5 years,respectively.18.4%.The 1-year,3-year and 5-year survival rates of patients of observed group were 85.7%,67.8%,and 40.5%,and the 1-,3-,and 5-year survival rates of patients of control group were 78.4%,56.2%,and 20.1%.The survival rate and disease-free survival rate of observed group and control group were statistically different(P=0.008/0.004).ConclusionsSynchronous hepatectomy and Splenectomy with periesophagogastric devascularization can be safely applied to patients with Hepatocellular carcinoma and portal hypertension with upper gastrointestinal bleeding without increasing surgical complications and perioperative mortality.It can make the patient’s PLT、WBC return to normal levels,and significantly reduce the lower esophageal-gastric variceal rebleeding rate,but increased the risk of postoperative portal vein thrombosis.It can not only delay the recurrence of Hepatocellular carcinoma to a certain extent,but also prolong postoperative tumor-free survival and overall survival of patients with Hepatocellular carcinoma and portal hypertension with upper gastrointestinal bleeding... |
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