同步腹腔镜肝切除联合脾切除术治疗原发性肝癌并发肝硬化性脾功能亢进的初步研究

Preliminary study on simultaneous laparoscopic hepatectomy combined with splenectomy in the treatment of hepatocellular carcinoma complicated with cirrhotic hypersplenism

目的探讨同步腹腔镜肝切除联合脾切除术治疗原发性肝癌并发肝硬化性脾功能亢进的安全性和临床疗效。方法对中南大学湘雅医学院附属株洲医院2017年1月至2020年6月间接受同步腹腔镜肝切除联合脾切除术的原发性肝癌并发肝硬化性脾功能亢进的15例患者临床资料进行回顾性分析,统计患者的客观缓解率、手术情况、术后并发症发生率、术后恢复时间、住院时间,比较手术后12 h、24 h、36 h、48 h患者的疼痛评分变化,比较手术前后患者的免疫功能指标、营养状况指标、肝功能指标、凝血功能指标、生活质量评分。结果15例患者均成功完成同步腹腔镜肝切除联合脾切除术,手术时间(204.57±18.42)min,术中出血量(118.24±19.15)mL;手术后12 h、24 h、36 h、48 h患者的疼痛评分逐渐降低([3.46±0.51)vs(2.92±0.45)vs(2.49±0.37)vs(2.10±0.34),P=0.006];术后引流管拔除时间(2.43±0.69)d;术后下床活动时间(3.97±0.58)d;术后并发症发生率20.0%,均恢复良好;住院时间(10.91±2.37)d。手术后,患者的CD3、CD4/CD8、血红蛋白、白蛋白、前白蛋白、AST、ALT、TBIL、TT、PT、APTT与手术前相比均无明显改变(P>0.05)。手术后,患者各方面的生活质量评分均高于手术前(P<0.05)。术后随访6~40个月,15例患者的客观缓解率为80.00%。结论同步腹腔镜肝切除联合脾切除术对原发性肝癌并发肝硬化性脾功能亢进的近期疗效良好,且其手术对免疫功能、营养状况、肝功能及凝血功能的影响轻微,术后并发症少,术后疼痛感逐渐减轻,有利于提高患者的生活质量。

Objective To investigate the safety and clinical efficacy of simultaneous laparoscopic hepatectomy combined with splenectomy in the treatment of hepatocellular carcinoma complicated with cirrhotic hypersplenism.Methods A retrospective analysis was performed on the clinical data of 15 patients with hepatocellular carcinoma complicated with cirrhotic hypersplenism who received simultaneous laparoscopic hepatectomy combined with splenectomy in Zhuzhou Hospital between Jan.2017 and Jun.2020.Objective remission rate,surgical condition,incidence of postoperative complications,postoperative recovery time and length of hospitalization were collected.Pain scores of patients at 12 h,24 h,36 h and 48 h after surgery were compared,and immune function indexes,nutritional status indexes,liver function indexes,coagulation function indexes and life quality scores of patients before and after surgery were compared.Results Simultaneous laparoscopic hepatectomy combined with splenectomy were successfully performed in all 15 patients,and the operation time was(204.57±18.42)min.The intraoperative blood loss was(118.24±19.15)mL.At 12 h,24 h,36 h and 48 h after surgery,the patient’s pain score decreased significantly[(3.46±0.51)vs(2.92±0.45)vs(2.49±0.37)vs(2.10±0.34),P=0.006].The drainage time was(2.43±0.69)d.The time of getting out of bed was(3.97±0.58)d.The incidence of postoperative complications was 20.0%,with good recovery.The length of hospitalization was(10.91±2.37)d.After surgery,CD3,CD4/CD8,hemoglobin,albumin,prealbumin,AST,ALT,TBil,TT,PT and APTT were not significantly changed compared with those before surgery(P>0.05).After surgery,the life quality scores of patients were higher than those before surgery(P<0.05).Follow-up ranged from 6 months to 40 months,and the objective response rate of 15 patients was 80.0%.Conclusion Simultaneous laparoscopic hepatectomy combined with splenectomy for hepatocellular carcinoma complicated with cirrhotic hypersplenism has a good short-term outcome,and the effects of the operation on immune function,nutritional status,liver function and blood coagulation function are slight,postoperative complications are less,postoperative pain is gradually reduced,which is beneficial to improve the life quality of patients.