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。

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(±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。

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)。

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。

To explore the effect of splenectomy and pericardial devascularization in the treatment of elderly primary liver cancer combined with portal hypertension.

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 (±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.

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).

Simultaneous hepatectomy combined with splenectomy and pericardial devascularization in the treatment of elderly primary liver cancer combined with portal hypertension is safe and effective.