联合肝切除术和脾切除术治疗肝细胞癌合并肝硬化及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].

作者信息

Cai Jian-qiang, Hu Jing-qun, Bi Xin-yu, Zhao Jian-jun, Che Xu, Xie Shi-liang, Shao Yong-fu, Zhao Ping

机构信息

Department of Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2004 Jan 2;84(1):6-8.

PMID:14990147

Abstract

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 x 10(9)/L in group A, significantly higher than that in group B (83 x 10(9)/L, P < 0.05); and the white blood cell count of group A increased to 10.4 x 10(9)/L, significantly higher than that of group B (4.19 x 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.

摘要

目的

探讨肝脾联合切除治疗肝细胞癌（HCC）合并肝硬化及脾功能亢进的远期疗效。

方法

回顾性分析102例HCC合并肝硬化及脾功能亢进患者的临床资料，其中57例行肝脾联合切除术（A组），45例仅行肝切除术（B组）。

结果

A组术中出血量为765 ml（100～2400 ml），与B组（720 ml，200～2000 ml）差异无统计学意义。A组手术并发症发生率为1.7%（1/57），显著低于B组（4.4%，2/45）。术后A组血小板计数升至275.8×10⁹/L，显著高于B组（83×10⁹/L，P<0.05）；A组白细胞计数升至10.4×10⁹/L，显著高于B组（4.19×10⁹/L，P<0.05）。A组术后γ-谷氨酰转移酶（肝硬化预后因素之一）为68 U/L，显著低于B组（132 U/L，P<0.05）。A组并发症发生率为29.8%（17/57），与B组（33.3%，15/45）差异无统计学意义。A组1年、3年和5年复发率分别为27.1%、48.6%和69.3%，B组分别为41.2%、50.0%和77.9%；A组1年、3年和5年生存率分别为92.6%、59.1%和41.8%，B组分别为80.3%、43.9%和29.1%。A组最长生存时间为12.9个月，显著长于B组（6.3个月，P<0.01）。