Takayama T, Makuuchi M, Yamazaki S, Hasegawa H
Department of Liver Surgery, National Cancer Center Hospital, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1989 Jul;90(7):1043-8.
To evaluate the clinical value of splenectomy for hepatic resection, a total of 20 patients with hepatocellular carcinoma and hypersplenism were examined focusing on a change of total serum bilirubin values after surgery. Both hepatectomy and splenectomy were simultaneously performed in 12 patients, and in 8 patients as a staged operation. Postoperatively, a significant depression of bilirubin values was observed in a group with the preoperative values between 1.0mg/dl and 2.0mg/ml. Three factors (bilirubin, albumin and prothrombin time) in clinical stage were improved just after splenectomy with a statistical significance (p less than 0.05) in a group received staged operation. In 7 out of 8 patients, clinical stages were getting better as one or two stages prior to the hepatectomies. Therefore, we recommend the addition of splenectomy to hepatectomy in the patients whose hyperbilirubinemia are assumed to be correlated with coexisting hypersplenism.
为评估脾切除术对肝切除术的临床价值，我们对20例肝细胞癌合并脾功能亢进患者进行了研究，重点关注术后总血清胆红素值的变化。12例患者同时进行了肝切除术和脾切除术，8例患者进行了分期手术。术后，术前胆红素值在1.0mg/dl至2.0mg/ml之间的患者组中观察到胆红素值显著下降。在接受分期手术的患者组中，脾切除术后临床分期中的三个因素（胆红素、白蛋白和凝血酶原时间）立即得到改善，具有统计学意义（p小于0.05）。8例患者中有7例，临床分期在肝切除术前提高了一到两个阶段。因此，我们建议在假定高胆红素血症与并存的脾功能亢进相关的患者中，在肝切除术中加行脾切除术。
