肝脾联合切除术治疗肝癌合并肝硬化脾功能亢进的远期疗效

Long-term effect of united hepatectomy and splenectomy on treatment of hepatocellular carcinoma complicated with cirrhosis and hypersplenism

目的 探讨肝脾联合切除术治疗肝癌合并肝硬化脾功能亢进的远期疗效。方法 对1 0 2例肝癌合并肝硬化脾功能亢进患者的临床资料进行回顾性分析。 5 7例行肝脾联合切除术 (A组 ) ,4 5例行单纯肝切除术 (B组 )。结果 A、B两组术中出血及术后并发症的发生率差异均无显著意义 (P >0 0 5 ) ,但术后血小板、白细胞的回升及与肝硬化预后相关的指标谷氨酰转肽酶 (GGT)数值的改善 ,A组明显好于B组 (P <0 0 5 )。两组 1、3、5年复发率分别为 2 7 1 %、4 8 6 %、6 9 3%及4 1 2 %、5 0 0 %、77 9% ;生存率分别为 92 6 %、5 9 1 %、4 1 8%及 80 3%、4 3 9%、2 9 1 % ,两组虽然没有统计学差异 ,但A组的生存情况均好于B组 ,而且A组复发患者的平均带瘤生存期 (1 2 9个月 )亦明显长于B组 (6 3个月 ,P <0 0 1 )。

Objective To discuss the long term effect of united liver and spleen resection on treatment of hepatocellular carcinoma (HCC) complicated with cirrhosis and hypersplenism Methods The clinical data of 102 patients of HCC complicated with cirrhosis and hypersplenism, 57 receiving united hepatectomy and splenectomy (group A), and 45 receiving hepatectomy only (group B), were retrospectively examined Results The volume of operative blood loss of group A was 765 ml(100～2 400 ml), not significantly different from that of group B (720 ml,200～2 000 ml) The operative morbidity was 1 7%(1/57) of group A, significantly higher lower than that of group B (4 4%,2/45) After the operation, the platelet count increased to 275 8×10 9/L in group A, significantly higher than that in group B (83×10 9/L, P <0 05); and the white blood cell count of group A increased to 10 4×10 9/L, significantly higher than that of group B (4 19×10 9/L, P <0 05) Post operative gamma glutamyl transferase, a prognostic factor for liver cirrhosis, of group A was 68 U/L, significantly lower than that of group B (132 U/L, P <0 05) The incidence of complication was 29 8%(17/57) in group A,not significantly different from that of group B (33 3%,15/45) The 1, 3, and 5 year recurrence rates were 27 1%, 48 6%, and 69 3% in group A, versus 41 2%, 50 0%, and 77 9% in group B, whereas the 1, 3, and 5 year survival rates were 92 6%, 59 1%, and 41 8% in group A, versus 80 3%, 43 9%, and 29 1% in the group B The longest survival time in group A was 12 9 months, significantly longer than that in group B (6 3 months, P <0 01) Conclusion United liver and spleen resection is a safe and effective modality for the treatment of HCC complicated with cirrhosis and hypersplenism