腹腔镜肝切除术加脾动脉结扎术在肝癌合并脾功能亢进治疗中的应用

Application of laparoscopic hepatectomy and splenic artery ligation in surgical treatment for hepatocellula carcinoma with hypersplenism

目的探讨腹腔镜肝切除术加脾动脉结扎术对肝癌合并脾功能亢进患者的治疗效果及可行性。方法 2010年8月至2012年2月选取18例肝炎后肝硬化、原发性肝癌合并脾功能亢进患者,均为肝左叶Ⅱ～Ⅲ段单发小肝癌,进行积极术前准备后先行腹腔镜下脾动脉结扎术,然后再按"七步断肝法"行肝左外叶切除术。结果 18例手术均获成功,手术时间(93.6±28.5)min,术中出血量(72.0±33.4)ml,术后平均住院日(5.2±1.1)d,仅有1例发生胆瘘,无脾脓肿及肝衰竭等并发症发生。患者术后1周白细胞及血小板计数恢复正常,6个月脾脏明显缩小、白细胞及血小板计数仍维持在正常范围。结论腹腔镜肝左外叶切除加脾动脉结扎术治疗肝功能较差的小肝癌合并脾功能亢进患者安全可行,具有微创优势,可作为其治疗的首选方法。

Objective To investigate the feasibility and efficacy of laparoscopic hepatectomy （ LH ） and splenic artery ligation （ SAL ） for hepatocellula carcinoma （ HCC ） with hypersplenism. Methods Clinical data of 18 patients with HCC and hypersplenism who underwented surgical treatment in our hospital from August 2010 to February 2012 were analyzed. These patients were single HCC at left lobe of liver（ Ⅱ and Ⅲ segments ）, who were firstly treated by laparoscopic SAL after preoperative preparation. Afterwards, laparoscopic lateral segment liver resection （ LLLR ） were implemented with method of seven steps hepatectomy. Results LLLR were completed in all the 18 cases with a mean operation time of （ 93.6 ± 28.5 ）min , mean blood loss of （ 72.0 ± 33.4 ）ml and mean postoperative hospital stay of （ 5.2 ± 1.1 ）d . Among the cases, only one patient formed biliary fistula, other patients recovered well without postoperative complications of splenic abscess and hepatic failure. In the first week after operation, white white blood cell （ WBC ） and blood platelet （ PLT ） level was a complete return to normality. After six months, the spleens of all cases obviously shrinked, WBC and PLT was still kept in normal range. Conclusions LLLR were completed in all the 18 cases with a mean operation time of （ 93.6 ± 28.5 ）min , mean blood loss of （ 72.0 ± 33.4 ）ml and mean postoperative hospital stay of （ 5.2 ± 1.1 ）d . Among the cases, only one patient formed biliary fistula, other patients recovered well without postoperative complications of splenic abscess and hepatic failure. In the first week after operation, white white blood cell （ WBC ） and blood platelet （ PLT ） level was a complete return to normality. After six months, the spleens of all cases obviously shrinked, WBC and PLT was still kept in normal range.