肝细胞癌合并肝硬化脾功能亢进患者行肝脾联合切除术的临床意义

Surgical treatment for hepatic carcinoma accompanied 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术与单纯肝癌切除术的临床疗效。方法:55例肝癌合并肝硬化脾功能亢进患者中,25例行肝癌联合脾切除,30例行单纯肝癌切除,对两种术式术后并发症、肝功能及血常规进行比较和分析。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%。两种术式的患者术后肝功能差异无统计学意义,而肝癌联合脾脏切除组能明显改善术后血常规。结论:应严格掌握肝癌联合脾脏切除的手术指征,同时应加强围手术期管理。肝癌联合脾切除术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： Hepatectomy were done in 30 hepatic carcinoma patients and hepatectomy combined splenectomy were done in 25 patients of hepatic carcinoma accompanied cirrhosis hypersplenism between 2000 to 2004. Those clinical material were analysed retrospectively. Results： The incidence of sepsis, upper digestive tract hemorrhage, ascite and jaundice in groups of hepatectomy and hepatectomy combined splenectomy were 10% and 0% ; 6.67% and 4% ; 20% and 16% ; 20% and 20% respectively. The liver function of patients in 2 groups had not significant difference, but the results of blood routine test in hepatectomy combined splenectomy group of 10th postoperative day were significantly better than those of preoperative. Conclusion： Hepatectomy combined splenectomy for hepatic carcinoma accompanied with cirrhosis hypersplenism was safe and effective, Better long term effects could obtained, if Patients were chosen by suitable operative indications strictly,meanwhile perioperative management should be strengthened.