Shi Rui, Zhang Ya-Min, Zhu Zhi-Jun, Deng Yong-Lin, Pan Cheng, Zheng Hong, Shen Zhong-Yang
Hepatogastroenterology. 2014 Jul-Aug;61(133):1363-7.
BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) mainly arises from underlying liver disease. Complicated liver cirrhosis and secondary hypersplenism are the most risk factors preventing surgical treatment of patients with HCC. The present study aimed at investigating the safety and long term outcome of patients with HCC and liver cirrhosis undergoing synchronous hepatectomy and splenectomy.
The clinical data of 306 cases of patients with HCC and liver cirrhosis undergoing curative hepatectomy were reviewed. 18 cases underwent synchronous hepatectomy and splenectomy. The rest 288 cases of HCC with hepatectomy only were compared in aspects of clinicopathological and surgical variables and surgical outcomes.
Preoperative hemoglobin and platelet count were significantly lower in splenectomy than non-splenectomy group (p<0.01, respectively). Patients undergoing combined splenectomy and hepatectomy needed longer surgery time and hospital stay time, and transfused much more blood intraoperatively (p=0.07, 0.03, and 0.02), and also experienced more portal vein thrombosis (p<0.01). The level of hemoglobin and platelet increased after splenectomy and finally to normal level one month postoperatively. There was no statistical difference of overall and disease-free survival of patients in splenectomy and non-splenectomy groups (p>0.05).
With strict selection, patients with HCC and hypersplenism could undergo combined splenectomy and hepatectomy safely.
背景/目的：肝细胞癌（HCC）主要起源于潜在的肝脏疾病。复杂的肝硬化和继发性脾功能亢进是阻碍HCC患者接受手术治疗的最主要危险因素。本研究旨在探讨HCC合并肝硬化患者同期行肝切除和脾切除的安全性及长期预后。
回顾性分析306例行根治性肝切除的HCC合并肝硬化患者的临床资料。其中18例行同期肝切除和脾切除。将其余288例仅行肝切除的HCC患者在临床病理、手术变量及手术结果方面进行比较。
脾切除组术前血红蛋白和血小板计数显著低于非脾切除组（分别为p<0.01）。同期行脾切除和肝切除的患者手术时间和住院时间更长，术中输血量更多（分别为p=0.07、0.03和0.02），门静脉血栓形成也更多（p<0.01）。脾切除术后血红蛋白和血小板水平升高，术后1个月最终恢复至正常水平。脾切除组和非脾切除组患者的总生存率和无病生存率无统计学差异（p>0.05）。
经过严格筛选，HCC合并脾功能亢进患者可安全地同期行脾切除和肝切除。
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