Matsumata T, Kanematsu T, Shirabe K, Takenaka K, Kitano S, Sugimachi K
Second Department of Surgery, Kyushu University, Faculty of Medicine, Fukuoka, Japan.
Hepatogastroenterology. 1990 Oct;37(5):461-4.
Twenty-four patients with hepatocellular carcinoma (HCC) concomitant with esophageal and/or cardial varices concurrently underwent hepatic resection for HCC and various treatments for varices. All patients had cirrhosis of the liver, and had either blue or white varices with "red color signs" endoscopically. These patients were assigned to two groups. Group A patients simultaneously underwent partial hepatectomy and selective shunt or direct interruption procedures (n = 13). Group B patients underwent hepatic resection and devascularization of the upper half of the stomach and/or preoperative or postoperative endoscopic injection sclerotherapy (n = 11). Seven patients in Group A had a tumor recurrence 4 to 58 months postoperatively, while in Group B, one of 11 patients had a tumor recurrence in the remnant liver. There was one patient in Group A with postoperative rebleeding from esophageal varices, and there was neither variceal bleeding nor variceal recurrence after treatment in Group B. Liver failure was the immediate cause of death in five, including three in-hospital deaths in Group A. Survival rates during the first 5 years in Group A were 75%, 67%, 31%, 21% and 10%, while the four-year survival rate in group B was 100%. In the light of this evidence, the treatment given to Group B is to be preferred.
24例肝细胞癌（HCC）合并食管和/或贲门静脉曲张的患者同时接受了肝癌肝切除术及多种静脉曲张治疗。所有患者均有肝硬化，内镜检查可见蓝色或白色静脉曲张并有“红色征”。这些患者被分为两组。A组患者同时接受了肝部分切除术和选择性分流或直接阻断手术（n = 13）。B组患者接受了肝切除术及胃上半部分去血管化和/或术前或术后内镜注射硬化治疗（n = 11）。A组7例患者术后4至58个月出现肿瘤复发，而B组11例患者中有1例在残余肝内出现肿瘤复发。A组有1例患者术后食管静脉曲张再出血，B组治疗后既无静脉曲张出血也无静脉曲张复发。肝功能衰竭是5例患者的直接死亡原因，其中包括A组3例院内死亡。A组前5年的生存率分别为75%、67%、31%、21%和10%，而B组的4年生存率为100%。鉴于此证据，B组的治疗方法更可取。
