小肝癌合并脾功能亢进的微创治疗的方法探讨

Radiofrequency ablation and laparoscopic splenectomy for the treatment of small hepatocellular carcinoma with hypersplenism

背景与目的：肝癌切除、脾切除是目前治疗肝癌合并脾功能亢进的主手段，但传统开腹手术创伤大。本研究探讨肝癌射频消融（radiofrequencyablation，RFA）联合腹腔镜脾切除（1aparoscopiCsplenectomy，LS）治疗小肝癌合并脾功能亢进的安全性及可行性。方法：27例肝癌（直径〈3cm）合并脾功能亢进患者，在全麻下行RFA及LS，分析其临床资料。结果：中转开腹脾切除1例，中转为手助腹腔镜脾切除2例，RFA治疗肝脏肿瘤31个。术中出血量110～900mL，中位出血量320mL，手术时间72-127min，中位手术时间107min；腹壁皮下广泛气肿1例，术后2d吸收；术后胰漏1例，经保守治疗治愈；术后腹腔大出血1例，再次开腹手术止血，恢复良好；腹水9例，经补充白蛋白和利尿等治疗，腹水消退；无死亡病例。结论：经选择的病例，RFA联合LS治疗小肝癌合并脾功能亢进微创、安全、可行。

Background and purpose： Liver cancer resection and splenectomy are the main methods to treat hepatocellular carcinoma and hypersplenism. The aim of this study was to discuss the safety and feasibility of simultaneous radiofrequency ablation （RFA） and laparoscopic splenectomy （LS） for the treatment of small hepatocellular carcinoma with hypersplenism. Methods： Twenty-seven patients with small hepatocellular carcinoma and cirrhotic hypersplenism underwent RFA and LS. The clinical data were also analyzed. Results： The surgery was converted to an open surgery in 1 patient, while laparoscopic splenectomy in a hand-assisted manner was performed in 2 patients. There were 31 liver tumors treated with RFA. Blood loss were 110-900 mL （mean=320 mL）. Operation time were 72-127 min （mean=107 min）. Subcutaneous emphysema occurred in 1 patient, and pancreatic leakage in another patient. Nine patients developed ascites, one patient suffered from massive haemorrhage, and emergency operation was adopted to stop bleeding. This patient recovered well after operation. No death was found during the hospitalization. Conclusion： Combining RFA with LS for the treatment of liver cancer and hypersplenism is minimally invasive, safe, and feasible.