合并脾功能亢进肝癌患者的外科治疗

目的 探讨肝癌切除合并脾脏切除对肝癌合并脾功能亢进患者的临床意义.方法 回顾性分析2004年3月至2006年1月我科收治的35例合并脾功能亢进肝癌患者的临床资料,其中切脾组12例,未切脾组23例.分析手术前后肝功能以及血小板、白细胞变化情况.结果 35例均成功切除肿瘤.切脾组12例患者术后脾功能亢进消失.术后1周,切脾组患者白细胞由术前的(3.2±1.7)×109/L上升到(8.5±5.3)×109/L,血小板计数由(52.6±23.7)×109/L上升到(245.3士94.6)×109/L(P＜0.01).未切脾组白细胞及血小板计数变化不大.切脾组肝脏功能恢复较快,术后1周基本恢复至术前水平.切脾组患者均接受了较为系统的术后化疗.术后随访2年,切脾组7例生存(58.3％)；未切脾组10例生存(43.5％).切脾组与未切脾组患者总的无瘤生存期分别为(16.4±4.3)个月和(14.3士5.2)个月(P＜0.005).结论 肝癌切除合并脾脏切除是治疗合并脾功能亢进肝癌患者的有效方法.

Surgical treatment of hepatocellular cancer with hypersplenism

Objective To determine the efficacy of liver cancer resection combined with splenectomy for patients with hepatocellular carcinoma with hypersplenism.Methods Among 35 patients with hepatocellular cancer and hypersplenism treated from March 2004 to January 2006 at our hospital,12 patients accepted simultaneous liver cancer resection and splenectomy (the splenectomy group)and 23 only accepted liver cancer resection (the non-splenectomy group).The liver function,platelets and white blood cells were analyzed retrospectively.Results All the operations were successfully carried out.Within 1 week after operation,the white blood cell count increased from (3.2 ± 1.7) × 109/L to (8.5±-5.3) × 109/L,the platelet count increased from (52.6±23.7) × 109/L to (245.3±94.6) ×109/L(P＜0.01) in the group of patients with combined splenectomy,while little change occurred in the non-splenectomy group.The liver function in the splenectomy group recovered to the preoperational value within 1 week.Two years after operation,7 (58.3％) patients were still surviving in the splenectomy group and the mean tumor-free survival was (16.4 ± 4.3) months compared with (14.3 ±5.2) months in 10 (43.5％) patients in the non-splenectomy group,(P＜0.005).Conclusion Liver cancer resection combined with splenectomy was efficacious to hepatocellular cancer with hypersplenism.