肝癌射频消融联合脾切除治疗小肝癌合并肝硬化、脾功能亢进

目的 探讨肝癌射频消融联合脾切除治疗小肝癌（病灶直径≤3 cm）合并肝硬化、脾功能亢进的疗效。方法 自2004年6月至2006年6月，中山大学附属第三医院肝胆外科共收治原发性小肝癌合并肝硬化、脾功能亢进患者184例。184例患者均联合行脾切除术，根据术中对肝癌的处理方式不同，将184例患者分为两组：肝癌切除组89例，射频消融组95例。分析两组的术中、术后情况。结果 两组间年龄、肿瘤大小、病理分期、术前肝功能分级、术后1年肿瘤复发转移率及生存率的比较，差异均无统计学意义（P〉0.05）。肝癌射频消融组的手术时间、术中失血量及输血量明显少于肝癌切除组（P〈0.05）。肝癌切除组术后再出血、顽固性腹水、肝功能衰竭等并发症发生率明显高于射频消融组（P〈0.05），ICU监护时间和住院时间长于射频消融组（P〈0.05）。结论 肝癌射频消融联合脾切除对肝功能影响小，并发症少，疗效与手术切除相近，适合于合并肝硬化门静脉高压症的肝癌。

Clinical effect of radio frequency ablation combined splenectomy on treatment of hepatocellular carcinoma complicated with cirrhosis and hypersplenism

Objective To investigate the therapeutic effect of radio frequency ablation combined splenectomy on treatment of hepatocellular carcinoma（HCC） complicated with cirrhosis and hypersplenism.Methods From June,2004 to June,2006,184 small HCC（≤3 cm） complicated with cirrhosis and hypersplenism patients were allocated to radio frequency ablation group（89 cases） and hepatectomy groups（95 cases）.All patients undergoing splenectomy.Intraoperative hemodynamic changes and the postoperative course of the two groups were compared.Results There was no difference between the 2 groups regarding the age,sex,tumor size,pathologic stage,preoperative liver function grade,one year after the transfer rate of tumor recurrence and survival（P〉0.05）.Intro-operative blood loss and transfusion requirements were decreased significantly in the radio frequency ablation group（P〈0.05）.Postoperative bleeding,liver function failure were higher in hepatectomy group （P〈0.05）,ICU stay and hospital stay were longer in hepatectomy group （P〈0.05）.Conclusion Radio frequency ablation combined splenectomy has less traumas,less postoperative complications,it can be used safely in the clinic treatment for patients with hepatocellular carcinoma complicated with cirrhosis and hypersplenism.