Combined Surgery For Patients With Primary Hepatocellular Carcinoma Complicated With Portal Hypertension

Background More than90%of primary liver cancer is hepatocellularcarcinoma.Cirrhosis is an important factor for the development of primary livercancer,about85%to95%of patients with hepatocellular carcinoma associate withcirrhosis， and portal hypertension is an important clinical symptom of livercirrhosis.With the advance in postoperative management and surgical techniques，patients with liver cancer resection after5-year survival increased from33%to69%.Butthere is still a dispute about the feasibility and efficacy of combined surgery for patientswith primary hepatocellular carcinoma complicated with portal hypertensionObjective Discuss about combine surgery for patients with primary hepatocellularcarcinoma complicate with portal hypertension.Method The clinical data of54cases of HCC with PH admitted from May2000toJuly2007at First Affiliated Hospital of Dalian Medical University.All the cases weredivided into2group.The case group (n=24)included the case performed combineoperation.The control group (n=30)included the case performed singlehepatectomy.Compared two groups among serum total bilirubin, albumin,platelet count,white blood cell count between preoperative and postoperative1month. Analyzedstatistically of postoperative mortality, upper gastrointestinal bleeding, ascites, liverfailure,1-,2-and3-year survival rates and other complications between two groups.Result After1month of the operation the platelet count,white blood cell,albuminincreased significantly in the case group (P<0.05),but there was no significant differentin total bilirubin of the case group between preoperative andpostoperative(P>0.05).There was significant different in platelet count,white blood cell,albumin of preoperative between the case group and the control group(P<0.05),butthere was no significant different in total bilirubin of preoperative between the casegroup and the control group(P>0.05).Two patients of case group (Child-Pugh B) deadafter the operation,one patient of the control group (Child-Pugh B) dead after theoperation,the case and control group was no significant difference(P>0.05).The causesof death were included upper gastrointestinal bleeding in1case (case group), liverfailure in2cases (1patient in case group and1patient in control group).After3-yearfollow-up,29cases death cause of: cancer recurrence in19patients (35.2%), liverfailure in8cases (14.8%), upper gastrointestinal bleeding in2cases(3.7%).Kaplan-Meier survival analysis of case group patients with1-,2-and3-yearmortality rate lower than that of the control group patients.The case group developedpostoperative ascites compared with the control group were statisticallysignificant(P<0.05).The number of patients of bleeding in the case group after1-,2-and3-year were4,6,7.The number of patients of bleeding in the control group after1-,2-and3-year were6,9,11.And there was no significant different between the case andcontrol group(P>0.05).But when the case group and control group patients withChild-Pugh A,there was no significant different between ascites.The number of patientsof bleeding in the case group after1-,2-and3-year were1,2,3.The number of patientsof bleeding in the control group after1-,2-and3-year.And there was significantdifferent between the case and control group(P<0.05).Conclusion1.Master surgical indications,strengthen perioperative protection of liverfunction and spleen,combine surgery for Child-Pugh A patients are safe and effective2.Only single hepatectomy for the HCC complicated with mild PH would lead to higherhemorrhagia rate and lower survival rate which suggesting that combined surgeries stillneed for a large number of prospective trial study to further confirmed.