联合脾切除对合并脾功能亢进直径≤5cm肝癌患者围手术期HBV再激活的影响

The impact of hepatectomy combined with splenectomy on perioperative hepatitis B virus reactivation in patients with hepatocellular carcinoma ≤ 5 cm and hypersplenism

目的探讨肝癌联合脾切除对合并脾功能亢进的肿瘤直径≤5cm肝癌患者围手术期HBVDNA载量的影响。方法采用回顾性病例对照研究方法，收集2008年5月至2015年6月胜利油田中心医院收治的167例合并脾功能亢进的肝癌（肿瘤直径≤5cm）患者的临床资料，包括联合脾切除患者64例，单纯肝癌切除患者103例。采用倾向评分匹配法，将患者分为联合脾切除组（联合组，n=61）和单纯肝癌切除组（对照组，n=61）。采用Logistic回归分析影响患者术后HBV激活的临床因素，分层x^2检验分析手术方式及术前抗病毒治疗对患者术后HBV激活的影响。结果术前PLI水平、Child-Pugh分级、肿瘤直径及手术方式是影响术后HBV再激活的独立危险因素（P〈0．05）。对照组术后HBV再激活率高于联合组（19．7％比6．6％，P〈0．05）。联合组中术前抗病毒治疗与未抗病毒治疗患者术后HBV激活率差异无统计学意义（5．3％比7．1％，P〉0．05）；对照组中未抗病毒治疗患者HBV激活率高于抗病毒治疗患者（26．1％比0，P〈0．05）。在术前抗病毒治疗患者，联合组与对照组HBV激活率差异无统计学意义（5．3％比0，P〉0．05）；在术前未抗病毒治疗患者，对照组HBV激活率高于联合组（26．1％比7．1％，P〈0．05）。结论对于直径≤5cm合并脾亢且术前未行规律抗病毒治疗的肝癌患者，联合脾切除可降低患者术后HBV激活率。对于术前抗病毒治疗患者，联合脾切除并未改善患者术后HBV激活状态。

Objective To investigate the impact of hepatectomy combined with splenectomy on hepatitis B virus （HBV） reactivation in patients with hepatocellular carcinoma （HCC） ≤5 cm and with hypersplenism. Methods This is a retrospective case-control study on 167 patients with HCC ≤5 cm and with hypersplenism who underwent hepatectomy combined with splenectomy at the Shengli Oilfield Central Hospital between May 2008 and June 2015. 64 patients underwent hepatectomy combined with spleneetomy, and 103 patients hepatectomy alone. The patients were assigned to the hepatectomy combined with splenectomy group （the combined group, n = 61 ） or the hepatectomy alone group （the control group, n = 61 ） using propensity score matching （PSM）. Logistic regression was used to evaluate the relative clinical factors associated with HBV reactivation. The stratified Chi-squared test was utilized to determine the impact of the surgical procedure and preoperative anti-viral therapy on postoperative hepatitis B virus reactivation of these patients. Results The serum PLT level, Child-Pugh grading, tumor diameter and surgical procedures were shown to be independent risk factors associated with postoperative HBV reactivation （ P 〈 0.05 ）. To study the impact of preoperative anti-viral therapy on postoperative HBV reactivation： - the incidence of HBV reactivation was higher in the control group than in the combined group （ 19.7% vs. 6.6% , P 〈 0.05 ）. In the com- bined group, there was no significant difference between patients who received anti-viral therapy and those who were treatment-naive （5.3 % vs. 7.1% , P 〉 0.05 ）. In the control group, a higher incidence of HBV reactivation was found in patients with treatment-naive than in patients who received anti-viral therapy （ 26. 1% vs. 0, P 〈 0.05 ）. For the patients who received anti-viral therapy, there was no significant difference between the combined group and the control group （ 5.3% vs. 0, P 〉 0.05 ）. In patients with treatment-naive, a higher incidence of HBV reactivation was observed in the control group than the combined group （26.1% vs. 7.1%, P 〈 0. 05 ）. Conclusions In patients who were not treated with antiviral therapy, hepatectomy combined with splenectomy decreased the incidence of postoperative HBV reactivation in patient with HCC ≤5 cm and with hypersplenism. For the patients who received preoperative anti-viral therapy, the incidence of postoperative HBV reactivation was not decreased with hepatectomy combined with splenectomy.