肝癌伴脾功能亢进的双介入治疗

目的评价联合应用肝动脉灌注化疗栓塞和部分性脾栓塞治疗肝癌伴脾功能亢进的临床价值及意义。方法收集肝癌伴脾亢58例,经导管肝动脉栓塞(TACE)同时行部分性脾栓塞(PSE),观察术前术后血细胞变化情况。结果TACE联合PSE治疗肝癌合并脾亢可明显改善患者外周血象,术后24小时、1周、2周及4周外周血白细胞、红细胞及血小板较栓塞前明显提高。结论对于肝癌合并脾功能亢进患者,在行肝动脉栓塞灌注化疗同时行部分性脾栓塞术,安全可靠,既能有效控制肿瘤发展,又能有效改善患者血象,提高机体免疫力和患者的生活质量。     

肝癌合并有脾亢的外科治疗

目的　探讨原发性肝癌合并脾功能亢进 (脾亢 )的一期联合手术治疗的可行性和适应证。方法　回顾性研究 2 0例原发性肝癌合并脾亢的病人 ,14例行肝癌切除 (均为不规则肝切除 )及脾切除 ,其中 9例附加贲门周围血管离断术 ;5例行术中肝癌微波固化治疗及脾切除加贲门周围血管离断术 ;1例行肝癌切除及术中肝癌微波治疗和脾切除加贲门周围血管离断术。结果　术后脾亢症状基本消灭 ,术后 1周血小板 ,WBC分别由原来的 4 5 .9× 10 9/L、3.3× 10 9/L上升到 2 4 7× 10 9/L、13.0× 10 9/L。无手术死亡 ,术后黄疸及腹水等并发症在出院时消退。结论　肝癌合并脾亢行肝切除或术中微波固化同时行脾切除及断流手术是一种安全可行的方法 ,可明显减少术后并发症并对后续治疗有益。     

原发性肝癌合并脾功能亢进患者肝脾联合切除对疗效的影响

目的探讨原发性肝癌合并脾功能亢进肝脾联合切除对疗效的影响。方法回顾分析23例原发性肝癌合并脾功能亢进的患者行肝癌切除联合脾切除（切脾组，n=10）和肝癌切除联合脾动脉结扎（非切脾组，n=13）手术前、后外周血中CD4、CD8、CD16、CD4／CD8、WBC及PLT的变化，并比较2组的生存率。结果术前2组患者的CD4、CD8、CD16、CD4／CD8、WBC及PLT差异无统计学意义；2组术中出血量和术后并发症发生率的差异亦无统计学意义的；术后3个月，切脾组CD4、CD16、CD4／CD8、WBC及PLT指标比术前显著升高（P〈0．01），且明显高于非切脾组（P〈0．01）；非切脾组术后上述各项指标无明显改变。2组生存率比较差异无统计学意义。切脾组中无一例因白细胞改变而影响术后辅助化疗，而非切脾组有7例因白细胞过低而被迫终止了化疗。结论肝癌切除联合脾切除有利于肝癌合并脾功能亢进患者术后免疫功能的恢复及术后化疗。     

肝癌合并肝硬化脾亢行肿瘤联合脾切除28例临床分析

目的探讨肝癌合并肝硬化脾功能亢进患者行原发性肝癌切除联合脾切除的临床疗效。方法对1996．1-2002．12间经我院手术治疗的28例肝癌合并肝硬化脾功能亢进患者的临床资料进行回顾性分析。结果28例患者行原发性肝脏癌肿一期切除联合脾切除，手术基本顺利，无手术死亡；术后脾亢症状基本消失。无严重手术并发症。结论对肝癌合并肝硬化脾功能亢进患者行原发性肝癌切除联合脾切除是安全有效的：加强围手术期处理是提高近期疗效的关键，且病理巨脾的切除对术后远期疗效亦是有益的。     

肝癌合并脾功能亢进的外科治疗

目的探讨原发性肝癌合并脾功能亢进（脾亢）的外科治疗方法和疗效。方法回顾性研究我院2000年8月至2010年8月41例原发性肝癌合并脾亢手术病例,11例合并重度脾亢患者行肝癌切除及脾脏切除（脾切除组）,其中3例附加贲门周围血管离断术;30例由于中度脾亢采用了肝癌切除及脾动脉结扎术（脾动脉结扎组）。结果术后两组脾亢症状基本消除,脾切除组和脾动脉结扎组术后1周血小板、白细胞均上升,两组间差异无统计学意义（P〉0．05）。脾切除组术后有2例胸腔积液,1例切口感染,3例术后黄疸及腹水并发症,脾动脉结扎组术后腹水2例,1例切口脂肪液化,1例胸腔积液,无手术死亡病例,术后并发症在出院时消失,两组术后并发症发生率差异有统计学意义（P〈0．05）。结论原发性肝癌合并巨脾可行肝切除及脾切除,而有消化道出血史可联合行断流术,手术是安全可行的;而对合并中度脾亢,肝切除合并脾动脉结扎同样近期能达到消除脾亢症状同时减少手术创伤。     

肝癌合并门静脉高压脾功能亢进105例的外科个体化治疗

目的：探讨肝癌合并门静脉高压脾功能亢进（脾亢）的外科个体化治疗措施。 方法：回顾性分析中山大学附属第一医院肝胆外科2002年1月至2011年12月10年间收治的105例肝癌合并门静脉高压严重脾亢的患者资料,57例行联合肝脾切除（联合组）,44例行单纯肝癌切除（肝切组）,4例行局部肝癌切除加脾动脉结扎术。 结果：联合组术后1~2周血小板及白细胞均恢复至正常,联合组与肝切组手术平均出血量分别为（903.62±139.24）ml和（802.56±146.52）ml（t = 3.535,P 〈 0.01）,差异有统计学意义,两组并发症分别为14例和15例,差异无统计学意义（χ2 =1.102,P 〉 0.05）,两组围手术期死亡各2例。 结论：联合肝脾切除治疗肝癌合并门静脉高压脾亢可作为首选,只要掌握好适应证,做好围手术期处理,手术是安全的,建立个体化治疗措施是降低术后并发症和死亡率,提高疗效的关键。     

肝脾联合切除术治疗肝癌合并门静脉高压症脾功能亢进10例

目的 探讨肝癌合并门静脉高压症脾功能亢进患者进行肝脾联合切除术的临床疗效。方法 回顾性分析肝脾联合切除术治疗肝癌合并门静脉高压症脾功能亢进10例患者的临床资料。结果 10例患者行肝脾联合切除术,其中5例附加贲门周围血管离断术。全组无手术死亡病例,无术后黑便及上消化道出血;术后脾功能亢进症状均明显改善;术后1例腹腔创面渗血,再次手术止血,痊愈出院。结论 肝癌合并门静脉高压症脾功能亢进患者行肝脾联合切除术,部分患者附加贲门周围血管离断术治疗是安全、有效的,但需严格掌握手术指征及加强围手术期处理。     

肝脾联合切除治疗肝癌合并脾亢

原发性肝癌合并有肝硬化脾功能亢进的存在,增加了手术的风险,影响患者的预后。因此,肝癌合并肝硬化脾功能亢进是肝癌外科治疗的难题,肝脾联合切除治疗肝癌合并脾亢是目前解决这一难题的重要治疗手段,对这一方法的手术原理、适应证、方式及处理过程等作一详细阐述。     

应用解剖脾门法行原位脾切除的体会

2004年1月至2005年12月我们采用解剖脾门法行原位脾切除34例，现报告如下。 资料与方法 1．一般资料：本组34例，男23例，女11例，年龄28~69岁，平均年龄48岁，34例中门脉高压30例，其中6例为肝癌合并门脉高压症，6例中有4例行脾切＋断流术＋肝左叶癌切除术，2例行脾切＋右肝癌切除术；其余24例均行脾切＋断流术。单纯脾切除术4例，原发性脾功能亢进1例，脾多发血管瘤1例，脾包膜下巨大血肿1例，     

部分性脾栓塞术在肝癌伴脾功能亢进治疗中的应用

目的评价部分性脾栓塞术（PSE）在原发性肝癌伴脾功能亢进介入治疗中的疗效及临床意义。方法原发性肝癌伴脾功能亢进患者12例，男10例，女2例．平均年龄51．1岁；肝功能Child－PughA级3例，B级9例；在行肝动脉插管化疗栓塞术（TACE）的同时行PSE；术后定期复查血常规和肝功能。结果本组脾栓塞面积为50％～60％，无脾脓肿等严重并发症。术后WBC和PLT显著提高（P〈0．05），并长期维持在较高水平，RBC数量和HG量无明显改变（P〉0．05）。TBIL、ALT和AST无明显变化（P〉0．05），TBA下降（P〈0．05）。结论PSE能纠正脾功能亢进，提高血WBC和PLT的数量，使原发性肝癌伴脾功能亢进患者的TACE能顺利进行，是一种安全、有效的治疗方法。     

脾动脉栓塞治疗肝癌伴肝硬化脾功能亢进20例体会

目的探讨脾动脉栓塞对原发性肝癌伴肝硬化脾功能亢进的治疗效果。方法采用常规的Seldinger法做脾动脉栓塞共20例,术前血小板计数1.9×10     

Splenic embolization in liver transplant recipients: early outcomes

Clinical improvement has been reported following splenic embolization for a wide variety of indications. Improvement following splenic embolization has been described in cirrhotic patients awaiting hepatic transplantation who are not candidates for surgical splenectomy. Occasionally, patients who have undergone hepatic transplantation have conditions that may also benefit from nonsurgical intervention with splenic embolization. Indications include persistent hypersplenism and pancytopenia precluding optimal treatment with antiviral therapy or chemotherapy, risk for persistent gastroesophageal variceal hemorrhage, and splenic artery steal syndrome attenuating hepatic arterial perfusion. Limited data is available on the outcome of splenic embolization in liver transplant recipients. We present the early outcomes of liver transplant recipients who were treated with splenic embolization. A retrospective chart review of all liver transplant recipients who underwent splenic embolization between 1997 and 2006 was performed, under minimal-risk study approval by the institutional review board. Five liver transplant recipients received splenic embolization: 3 for persistent hypersplenism, 1 for increased risk of gastroesophageal variceal hemorrhage, and 1 for splenic artery steal syndrome. The patients with hypersplenism demonstrated hematologic improvement, the patient with gastroesophageal varices did not experience any hemorrhage on follow-up, and the patient with splenic artery steal experienced resolution of the steal phenomenon. Postembolization syndrome was observed but no splenic abscess or death occurred. Mean follow-up was 20.2 months. In conclusion, splenic embolization is a safe and effective nonsurgical alternative for a variety of indications in liver transplant recipients.     

同期肝切除联合脾切除在肝癌合并门静脉高压患者中的应用探讨

目的探讨肝癌合并门静脉高压伴食管静脉曲张破裂出血的患者同期行肝癌切除和脾切除的安全性及可行性。 方法回顾性分析2002年1月至2018年1月期间42例肝癌合并门静脉高压伴食管静脉曲张破裂出血行肝脾联合切除患者的临床资料。记录手术时间、术中出血量及术后并发症发生例数。采用门诊复查或电话随访方式随访，随访截至时间为2022年1月。 结果开腹联合切除33例（78.6%），腹腔镜联合切除9例（21.4%）。其中8例行同期肝切除合并脾切除（19.0%），34例行同期肝切除合并脾切除同时加做贲门周围血管离断（81.0%）。术中出血量（771.4±500.2）ml，术中均未行肝门阻断；手术时间（5.6±2.6）h；42例患者术后病理学检查均证实为肝细胞癌。术后无围手术期临床死亡病例；术后3~6 d均恢复正常饮食。术后发生门脉系统血栓形成最为常见，共计出现32例（76.2%），单侧或者双侧胸腔积液21例（50.0%），肝周或者脾窝脓肿形成3例（7.1%），胆瘘2例（4.8%），严重门脉及脾静脉血栓形成致持续高胆红素血症1例（2.4%），后介入行肠系膜上动脉置管行肝素钠及尿激酶溶栓后好转。术后随访<5个月的3例（7.1%），超过1年的患者39例（92.9%），超过5年的患者9例（21.0%）。其中17例肿瘤复发或转移，并行进一步治疗（40.5%）；13例复查胃镜出现不同程度食管静脉曲张（31.0%）。 结论对于肝癌合并门静脉高压伴脾功能亢进及食管静脉曲张破裂出血的患者，可选择行肝脾联合切除，具有一定的安全性和可行性。     

Use of hepatectomy and splenectomy to treat hepatocellular carcinoma with cirrhotic hypersplenism

BACKGROUND: The aim of this study was to compare the outcome after simultaneous hepatectomy and splenectomy with that after hepatectomy alone for hepatocellular carcinoma with associated hypersplenism. METHODS: Two hundred and four patients with hepatocellular carcinoma and cirrhotic hypersplenism were divided non-randomly into two groups. Ninety-four underwent simultaneous hepatectomy and splenectomy and 110 underwent hepatectomy alone. White blood cell (WBC) and platelet counts, total serum bilirubin levels, immune function, incidence of complications and 5-year survival rates in the two groups were compared. RESULTS: WBC and platelet counts, distribution of T cell subsets, and levels of bilirubin, interferon gamma and interleukin 2 were different between the two groups after operation. All patients who underwent hepatectomy and splenectomy but only 15.5 per cent of those who had hepatectomy alone completed adjuvant chemotherapy. The 5-year tumour-free survival rate was significantly higher after hepatectomy and splenectomy than after hepatectomy alone (37 versus 27.3 per cent; P = 0.003), although overall survival rates were similar. CONCLUSION: Simultaneous hepatectomy and splenectomy was associated with improved 5-year tumour-free survival in patients with hepatocellular carcinoma and hypersplenism.     

Comparison of two different percutaneous splenic artery interventions in the treatment of hypersplenism: preliminary report

BACKGROUND: Splenomegaly and hypersplenism occur in patients with chronic liver disease and liver transplant recipients. The traditional treatment for hypersplenism is surgical removal. Percutaneous interventional methods, such as partial splenic embolization, are alternatives to surgery for hypersplenism. This article gives preliminary findings for a new percutaneous technique in which a narrowed stent is placed in the splenic artery. METHODS: The study focused on 10 patients (eight males and two females) who were treated for hypersplenism. Partial splenic embolization was performed in six patients (age range, 1-43 years) who were waiting for liver transplantation, and narrowed stents were placed in four patients (age range, 12-47 years) who had undergone either orthotopic two patients) or heterotopic two patients) liver transplantation. For embolization, the splenic artery was catheterized and polyvinyl alcohol particles were infused to the distal branches, reducing blood flow in the spleen by 40% to 50%. In the other cases, a narrowed stent was deployed to the middle portion of the splenic artery. RESULTS: Hypersplenism was successfully treated in all 10 cases. Compared with partial splenic embolization, placement of narrowed stents was associated with lower frequencies of postintervention fever and pain, shorter hospital stay, and decreased need for antibiotics. In addition to treating hypersplenism, narrowed-stent placement also completely resolved splenic artery steal syndrome in the two patients (orthotopic liver transplant recipients) with this condition. CONCLUSION: Percutaneous placement of a narrowed stent in the splenic artery is a promising new technique for treating hypersplenism and splenic arterial steal syndrome.     

Transcatheter treatment of splenic artery aneurysms (SAA). Report of two cases

Splenic artery embolization with steel coils was performed in two patients who both had large splenic artery aneurysms and hepatic cirrhosis complicated by hypersplenism. A good clinical effect was noticed after the procedure. It was concluded that this treatment is safe and effective and decreases the risk of splenic artery rupture. It also corrects hypersplenism. Transcatheter embolization appears to be a preferable alternative to surgery in such cases.     

脾切除术与部分性脾栓塞术治疗肝硬化脾功能亢进的比较研究

目的对比研究脾切除术（包括开腹脾切除和腹腔镜下脾切除）与部分性脾栓塞术治疗肝硬化脾功能亢进的疗效。方法回顾分析我院1999年3月至2006年12月42例获得完整随访资料的行外科手术或介入处理的42例肝硬化脾功能亢进患者的临床资料，其中外科切除组19例，部分性脾栓塞组23例，比较观察两组术后第3、7、14、30天及1年的外周血象主要指标（RBC、WBC、PLT）、术后1个月及1年的NK细胞活性、术后住院时间、住院费用及并发症的发病率。结果两组患者术后不同时间的血细胞水平差异无统计学意义（P〉0．05），部分性脾栓塞组患者术后住院时间及住院费用明显低于外科手术组（P〈0．05），术后1个月及1年外科手术组NK细胞活性低于部分性脾栓塞组，差异具有统计学意义（P〈0．05）。结论外科脾切除与部分性脾栓塞治疗肝硬化脾功能亢进均有确切疗效，部分性栓塞在减少患者住院时间、降低住院费用及维持患者免疫功能方面更有优势，但治疗方案需个体化。