原发性肝癌合并肝硬化及脾功能亢进围手术期处理及手术方式的选择

Perioperative management and surgical treatment of primary hepatocellular carcinoma with cirrhosis and hypersplenia

目的探讨原发性肝癌合并肝硬化及脾功能亢进的围手术期处理和术式选择。方法选取2005年3月至2015年3月间收治的60例原发性肝癌合并肝硬化及脾功能亢进的患者,其中采用肝癌切除+脾切除20例,肝癌切除+脾切除+贲门周围血管离断术15例,肝癌切除+脾动脉结扎13例,单纯肝癌切除12例,观察4种手术方式的治疗效果。结果单纯肝癌切除患者和肝癌切除+脾动脉结扎患者术后白细胞(WBC)、血小板(PLT)水平明显低于肝癌切除+脾切除+贲门周围血管离断术和肝癌切除+脾切除患者,差异有统计学意义(P<0.05);术后单纯肝癌切除患者谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(Tbil)和CD8^+T细胞比较明显高于其他3组,CD4^+和CD4^+/CD8^+T细胞比例明显低于其他3组,差异有统计学意义(P<0.05)。结论肝癌切除联合对脾脏进行处理对原发性肝癌合并肝硬化及脾功能亢进患者治疗效果明显,能够提高患者术后生存时间和生存质量。

Objective To investigate the perioperative management and surgical treatment of primary hepatocellular carcinoma with cirrhosis and hypersplenia. Methods Between March 2005 and March2015 in Beijing Haidian Hospital,60 cases of primary hepatic carcinoma with liver cirrhosis and hypersplenia were selected. Among them,20 cases received liver resection plus splenectomy; 15 cases received resection of liver cancer and splenectomy with pericardia vascular disconnection; 13 cases received resection of liver cancer and ligation of splenic artery; 12 cases received simple resection of liver cancer. The treatment effect of four kinds of surgical methods were compared. Results After operation,platelet（ PLT） and white blood cell（ WBC） of patients with simple liver cancer resection and resection of liver cancer and splenic artery ligation were significantly lower than the patients with resection of liver cancer and splenectomy with pericardia vascular disconnection,and resection of liver cancer and ligation of splenic artery,the difference had statistically significant（ P〈0. 05）; Alanine aminotransferase（ ALT）, total bilirubin（ Tbil）,aspartate aminotransferase（ AST） and CD8 of patients with simple resection of liver cancer were significantly higher than other three groups after surgery,CD4,CD4/CD8 was significantly lower than the other three groups,all with statistical difference（ P〈0. 05）. Conclusion The treatment of liver cancer with liver resection combined with the treatment of spleen is obvious,can improve the survival of patients after surgery,and improve the quality of life of patients.