Percutaneous Microwave Coagulation Therapy And Hepatectomy Combined With Splenectomy Plus Pericardial Devascularization For Hepatic Carcinoma Complicated With Portal Hypertension

Objective:To investigate the comprehensive treatment of hepatic carcinoma complicated with portal hypertension by comparing the incidence of complications and the survival rate of postoperation between percutaneous microwave coagulation therapy combined with splenectomy plus pericardial devascularization and hepatectomy combined with splenectomy plus pericardial devascularization.Methods:From December,1992 to December,2008,60 patients in our hospital with hepatic carcinoma complicated with portal hypertension were allocated to percutaneous microwave coagulation therapy group (26 cases) and hepatectomy group(34 cases). Patients in hepatectomy group undergone hepatectomy and splenectomy plus pericardial devascularization at the same time. Patients in percutaneous microwave coagulation therapy group first undergone splenectomy plus pericardial devascularization.then undergone percutaneous microwave coagulation therapy 1-2 weeks later.The incidence of complications and the survival rate of postoperation of the two groups were compared.Results:Hepatectomy group (n=34) has died in 1 case 7 days after surgery, severe heart and lung complications in 1 case,massive ascites in 3 cases, pleural effusion in 2 cases, diaphragm effusion in 2 cases, portal vein thrombosis in 3 cases. The postoperative 1,2,3-year survival rates were 93.9%,78.8%,57.6%. Reasons of death were recurrence of hepatic carcinoma, liver failure, upper gastrointestinal bleeding. Percutaneous microwave coagulation therapy group (n=26) has no death, pleural effusion in 1 case, ascites in 1 case, portal vein thrombosis in 1 case. The postoperative 1,2,3-year survival rates were 95.8%,83.3%,66.7%. Reasons of death were recurrence of hepatic carcinoma, liver failure.Conclusion:The study shows that percutaneous microwave coagulation therapy combined with splenectomy plus pericardial devascularization and hepatectomy combined with splenectomy plus pericardial devascularization are feasible. The choice of therapeutic method should be based on liver function, tumor location and size, general condition of patients.