Nagasue N, Yukaya H, Ogawa Y, Chang Y C, Kohno H, Nakamura T
Second Department of Surgery, Shimane Medical University, Izumo, Japan.
Arch Surg. 1988 Apr;123(4):509-13. doi: 10.1001/archsurg.1988.01400280123025.
Ten patients with both hepatocellular carcinoma (HCC) and esophageal or esophagogastric varices were concurrently treated by partial hepatic resection and distal splenorenal shunt. All the patients were men aged from 45 to 71 years. Four patients had had recent episodes of variceal bleeding. Six patients were considered to be at high risk for bleeding, as their varices were large and had "red color signs" endoscopically. Liver cirrhosis was associated with all cases. The grade of hepatic dysfunction was Child A in seven and Child B in three patients. As the HCCs were relatively small, partial wedge hepatectomy was carried out in all patients. Five patients underwent the original Warren shunt, but the remaining five had modified shunts with expanded polytetrafluoroethylene (Gore-Tex) interposition. There was no operative mortality within one month. Nine patients with patent shunts had no variceal bleeding despite the fact that three of them had tumor recurrence in the liver. Hepatic encephalopathy occurred transiently in only one instance. Six patients were alive at the time this report was written, eight to 49 months after operation. Five were free of cancer and one had tumor recurrence. This result may indicate that relatively small HCCs and esophageal varices can be simultaneously treated by limited hepatic resection and distal splenorenal shunt in patients with Child A or B liver disease.
10例同时患有肝细胞癌（HCC）和食管或食管胃静脉曲张的患者接受了部分肝切除术和远端脾肾分流术联合治疗。所有患者均为男性，年龄在45至71岁之间。4例患者近期有静脉曲张出血发作。6例患者因静脉曲张较大且内镜检查有“红色征”而被认为有出血高风险。所有病例均伴有肝硬化。肝功能分级为Child A级的有7例，Child B级的有3例。由于HCC相对较小，所有患者均行部分楔形肝切除术。5例患者接受了最初的Warren分流术，其余5例采用聚四氟乙烯（Gore-Tex）补片改良分流术。术后1个月内无手术死亡病例。9例分流术通畅的患者尽管其中3例肝脏有肿瘤复发，但均未发生静脉曲张出血。仅1例患者出现短暂性肝性脑病。撰写本报告时，6例患者存活，术后8至49个月。5例无癌，1例有肿瘤复发。这一结果可能表明，对于Child A级或B级肝病患者，相对较小的HCC和食管静脉曲张可通过有限肝切除术和远端脾肾分流术同时治疗。
