射频消融联合脾切除治疗小肝癌伴脾功能亢进53例临床研究

Clinical research on radiofrequency ablation combined with splenectomy in 53 patients with small hepatocellular carcinoma associated with hypersplenism

目的 探讨射频消融联合脾切除术治疗小肝癌伴脾功能亢进的效果.方法 回顾分析手术治疗的100例小肝癌伴脾功能亢进患者资料.按照术中处理方式不同,将患者分为两组,两组患者均接受了脾切除.其中观察组53例,行肝癌射频消融术;对照组47例,行肝癌切除术.比较两组术中、术后状况.结果 观察组热缺血时间、手术时间、术中失血量、住院时间、输血量等均显著少于对照组患者,差异有统计学意义（P＜0.05）.观察组术后并发症发生率（7.6％,4/53）显著低于对照组（44.7％,21/47）,差异有统计学意义（P＜0.05）.两组术后1、3、5年生存率（分别为100.0％、75.5％、67.9％比97.9％、76.6％、68.1％）及无瘤生存率（分别为96.2％、57.5％、41.7％比93.5％、58.3％、43.8％）,差异无统计学意义（P＞0.05）.结论 采用肝癌射频消融联合脾切除术治疗小肝癌伴脾功能亢进患者,不但可达到与手术切除相同的疗效,且可显著减少并发症,术后恢复快,具有较高的推广价值.

Objective To explore the efficacy of radiofrequency ablation （RFA） combined with splenectomy in patients with small hepatocellular carcinoma （sHCC） associated with hypersplenism.Metheds The data of 100 patients with sHCC associated with hypersplenism who received RFA or hepatectomy combined with splenectomy were analyzed retrospectively.The patients were divided into the observation group and the control group based on the intraoperative approach.Fifty-three patients who received RFA and splenectomy were in the observation group,and the remaining 47 patients who received hepatectomy and splenectomy were in the control group.Multiple intraoperative and postoperative factors were compared between the two groups.Results There were significant differences between the two groups in warm ischemia time,operation time,intraoperative blood loss,hospital stay,and amount of blood transfusion （P 〈 0.05）.The postoperative complication rate of the observation group （7.6%,4/53） was significantly lower than the control group （44.7 %,21/47） （P 〈 0.05）.There were no significant differences in 1-,3-,and 5-year survival （respectively,100.0%,75.5%,and 67.9% vs 97.9%,76.6%,and 68.1%） and in disease free survival （96.2%,57.5%,and 41.7% vs 93.5%,58.3%,and 43.8% respectively） between the two groups （P 〉 0.05）.Conclusion RFA combined with splenectomy can be considered as an alternative treatment for patients with sHCC associated with hypersplenism.