Portal hypertension _7328 Surgical treatment of he -

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Portal hypertension in the surgical treatment of hepatocellular carcinoma

Liver lesions, and further CT examination and AFP determination for the definite diagnosis by surgery and pathology Wang fact, this tip of PHT patients should be regularly reviewed,[link widoczny dla zalogowanych], Li B ultrasonic examination Results Taiwan AFP barium given only 4 simple,[link widoczny dla zalogowanych], non-invasive , and can double check, can be found in liver tumors earlier, so that patients receive timely treatment 3.2PHT PHC indications for surgery combined with liver resection than is indicated. The same, we must also consider the PHT of the patient, liver function which is most important. Patients with cirrhosis of the liver due to long-term, history of hypersplenism and liver dysfunction. Compensatory ability of the liver reserves and decrease blood coagulation damage. Coupled with the trauma of anesthesia and surgery. Have an increased risk of surgery, so the severe hepatic dysfunction Cautious surgery. The group of liver function in patients with Child-PughB grade 3 cases. Treatment and other measures by the liver. Improved liver function, underwent surgery treatment. And postoperative recovery was smooth. Liver function Child-PughA 6 cases were successful surgery and recovery so we believe that grade A liver function and possible surgery; B liver treatment is first class. Possible improvement of liver function after surgical treatment and surgical operation time of 3.3 the choice of combined PHT PHC patients, surgery is necessary to consider radical resection of cancer, forks should consider reducing portal pressure and hypersplenism lifted in order to achieve both the removal of liver tumor, and then fork to control upper gastrointestinal bleeding purposes. Due to the long-term cirrhosis, liver damage, elevated portal pressure, esophageal and gastric veins Rights sheets, so surgery should seek to simple trauma. And can achieve these goals. Did not find preoperative and intraoperative findings and confirmed the PHC,】 62000 on 4O Medicine Volume 23, some scholars claim Shandong until splenectomy, devascularization or shunt 1 to 2 months before resection for liver tumors . However, most scholars believe that those who have been diagnosed as PHC. Wait for l ~ 2 months of the purposes of liver tumor resection is too late. . We believe that, PHT combined PHC patients, intraoperative findings, or both were diagnosed before surgery, treatment should focus on the tumor so. Condition is not allowed, should be first liver tumor resection, the other hand, should strive for liver resection, splenectomy plus devascularization same purposes, in particular, to have moderate to severe upper gastrointestinal bleeding esophageal varices and a history of not only the availability of timely treatment, and remove the pain and anguish of reoperation in this group is expected to plan according to the same period 8 patients successfully completed the surgery. Patients should be aware of the following: ① line liver resection, the use of intermittent hepatic portal blocking the ... irregular liver resection line,[link widoczny dla zalogowanych], so to minimize the damage. When the right hepatic lobe tumor resection, because of the need for bilateral costal margin incision. Trauma, so the elderly,[link widoczny dla zalogowanych], in general, poor patients should be Cautious. ② left liver tumor line left costal margin incision, one should first probe after the abdominal cavity of liver cancer cases, confirmation can be excised. First splenectomy, devascularization, the left upper abdominal asked leave large space is conducive to the liver exposed, isolated and removed. Press Act, the group left hepatic lobectomy in 2 cases, partial excision of the left liver lobe, and left hepatectomy in 1 case, were revealed very good. L through this incision and exploration within the left lobe tumor patients of about 3cm × 3cm × 4cm, the right hepatic lobe near the former may also be palpable hilar and about 2cm × 2cm × 2.5cm size of the tumor, so the line of resection is not, as the take along of bleeding in patients with no history,[link widoczny dla zalogowanych], nor splenectomy, devascularization @ right hepatic tumor should be cut under the right costal margin, to be right hepatic tumor resection, according to condition to decide whether splenectomy, devascularization or only line of gastric coronary vein ligation for 4 patients in this group have made a year removed, surgery will be extended to the left costal margin incision, as long as a smooth splenectomy, devascularization or gastric coronary vein ligation can be. If the condition does not allow. May terminate the operation, in the future to decide whether the disease further, according to splenectomy, devascularization and so on. Some scholars think that, if conditions possible liver resection plus preoperative and postoperative endoscopic sclerotherapy (EIS) or endoscopic vessel ligation (Ev1) treatment of esophageal and gastric varices, the combination of these surgical lower body injury, but requires a certain endoscopic endoscopic equipment and skilled physicians operating experience. Our data show that, PHT units and PHC not difficult to diagnose. After diagnosis, if available, should the same period for the purposes of resection to prolong survival time. Improve their quality of life. 4

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