肝癌合并肝硬化脾功能亢进的外科治疗

Surgical treatment for hepatic carcinoma accompanied with cirrhosis hypersplenism

目的：探讨肝癌合并肝硬化脾功能亢进患者，行肝癌联合脾脏切除的适应症，并与单纯肝癌切除的进行比较。方法：对2000年-2004年间的55例肝癌合并肝硬化脾功能亢进患者，25例行肝癌联合脾切除，30例行单纯肝癌切除，将全部临床资料进行回顾性分析。结果：单纯肝癌切除组与肝癌联合脾脏切除组术后感染、消化道出血、腹水、黄疸的发生率分别为：10％和0％；6．67％和4％；20％和16％；20％和20％。两种术式术后肝功比较无显著性差异。而肝癌联合脾脏切除组能明显改善术后血常规。结论：只要严格掌握手术指征：①全身情况良好，无远处转移；②肝功能Child B级以上，如为Child C级，需经系统保肝治疗，使其达到Child B级；③既往有呕血、黑便史；④脾功能亢进，外周血白细胞〈4×10^9／L，血小板〈60×10^9／L；同时加强围手术期管理，这一术式治疗肝癌合并肝硬化脾功能亢进是安全可行的。

Objective：To explore the indications and effects of hepatectomy combined splenectomy for hepatic carcinoma accompanied cirrhosis hypersplenism. Methods： Thirty cases of hepatic carcinoma and 25 cases of hepatic carcinoma accompanied cirrhosis hypersplenism were performed with hepatectomy combined splenectomy. Clinical data was analyzed retrospectively. Results ： The incidence of sepsis, upper digestive tract hemorrhage, ascite and jaundice were 10% and 0% ,6.67% and 4% ,20% and 16% ,20% and 20% respectively. The liver function of 2 groups had not any difference, but the results of blood regular test in hepatectomy combined splenectomy group 10 days after operation were significantly better than those of preoperative. Conclusion： Hepatectomy combined splenectomy for hepatic carcinoma accompanied by cirrhosis hypersplenism was safely and effectively, long term effect is good, if patients were choosed by suitable operative indications strictly,meanwhile management perioperative should be strengthened.