不同治疗方法对肝癌合并脾功能亢进的疗效分析

目的探讨不同方法治疗肝癌合并脾功能亢进患者的临床疗效和意义。方法回顾性分析2007～2010年收治的63例肝癌合并脾功能亢进患者的临床资料,其中,26例行单纯肝癌切除术（Ⅰ组）,18例行肝切除同时联合脾切除或脾动脉结扎（Ⅱ组）,19例行术前部分性脾栓塞（partial splenic embolization,PSE）联合肝切除（Ⅲ组）。观察3组治疗前后外周血细胞变化情况,分析围术期出血、输血和并发症等情况,比较各组1、3年总生存率。结果联合手术组术后外周血白细胞、血小板均较单纯手术组明显改善,与术前PSE组无明显差异。术前PSE组患者出血量和输血量均较Ⅱ组和Ⅰ组明显减少（P〈0.05）。联合手术组和术前PSE组的术后并发症明显低于单纯手术组患者,Ⅰ、Ⅱ和Ⅲ组患者1、3年总生存率分别为：68.5%、38.1%,82.8%、52.6%和85.5%、56.3%,Ⅰ组患者显著低于Ⅱ组和Ⅲ组（P〈0.05）。结论肝脾联合手术和术前PSE是治疗肝癌合并脾功能亢进安全、有效的方法。术前PSE治疗更适合严重的门脉高压、巨脾、老龄和体质差患者。

Clinical analysis of diverse treatment for hepatocellular carcinoma with hypersplenism

Objective To evaluate the efficacy of diverse treatment for hepatocellular carcinoma with hypersplenism.Methods The clinical data of 63 patients of hepatocellular carcinoma with hypersplenism from 2007 to 2010 were retro spectively analyzed,26 patients only accepted hepatectomy (group Ⅰ),18 patients accepted hepatectomy in combination with splenectomy or splenic artery ligation (group Ⅱ),and 19 patients underwent partial splenic embolization (PSE) before operation (group Ⅲ).The platelets,white blood cells,complication,intro-operative blood loss and transfusion requirement and survival were analyzed retrospectively.Results The WBC and PLT counts in the blood samples of the PSE group were higher than those in the single operation group after operation.There were no singnificant differences in the WBC and PLT counts between the PSE group and the combined group.Intro-operative blood loss and transfusion requirement in the PSE group were lower than in the single operation group and the combined group (P < 0.05).Postoperative complications in the PSE group and the combined group were significantly less than that in the single operation group.The 1-year and 3-year survival rates were 68.5% and 38.1% for group Ⅰ,82.8% and 52.6% for group Ⅱ,85.5% and 56.3% for group Ⅲ,respectively.Conclusion Synchronous splenectomy and preoperativ PSE can increase the safety and effectiveness of hepato cellular carcinoma with hypersplenism.The treatment of preoperative PSE is more suitable for severe portal hypertension,the megalosplenia,older age and physical poor patients.