Hepatic Surgery Center, Tongji Hospital, Tongji Medical College.
Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Medicine (Baltimore). 2021 Jan 29;100(4):e24326. doi: 10.1097/MD.0000000000024326.
The spleen plays an important role in tumor progression and the curative effects of splenectomy before hepatectomy for hypersplenism and hepatocellular carcinoma (HCC) are not clear. We investigated whether splenectomy before hepatectomy increases survival rate among patients with HCC and hypersplenism compared with that of patients who underwent synchronous hepatectomy and splenectomy or hepatectomy alone.Between January 2011 and December 2016, 266 patients who underwent hepatectomy as a result of HCC and portal hypertension secondary to hepatitis were retrospectively analyzed. Their perioperative complications and survival outcome were evaluated.Patients underwent synchronous hepatectomy and splenectomy (H-S group) and underwent splenectomy before hepatectomy (H-preS group) exhibited significantly higher disease-free survival (DFS) rates than those of patients underwent hepatectomy alone (H-O group). The DFS rates for patients in the H-S group, H-preS group, and H-O group were 74.6%, 48.4%, 39.8%, and 80.1%, 54.2%, 40.1%, and 60.5%, 30.3%, 13.3%, at 1, 3, and 5 years after surgery, respectively. Tumor size, tumors number, and levels of alpha fetoprotein (AFP) were independent risk factors for DFS. Gender and tumor size were independent prognostic factor for overall survival (OS). The preoperative white blood cell (WBC) and platelet (PLT) counts were significantly higher in the H-preS group than in those of the H-S group and the H-O group. After operation, the WBC and PLT counts in the H-S group and H-preS groups were significantly higher compared to those of the H-O group.No matter splenectomy before hepatectomy or synchronous hepatectomy and splenectomy, hepatectomy with splenectomy may improve DFS rates in patients with HCC and hypersplenism, and splenectomy before hepatectomy alleviates hypersplenism without an increased surgical risk.
脾在肿瘤进展中起着重要作用，对于肝硬化和肝细胞癌（HCC）患者行脾切除术的疗效尚不清楚。我们研究了与同期行肝切除术和脾切除术或单纯肝切除术相比，肝切除术前行脾切除术是否能提高HCC 和脾功能亢进患者的生存率。
回顾性分析了 2011 年 1 月至 2016 年 12 月期间 266 例因乙型肝炎后肝硬化门静脉高压行肝切除术的患者。评估了其围手术期并发症和生存结果。
行同期肝切除术和脾切除术（H-S 组）和肝切除术前行脾切除术（H-preS 组）的患者无疾病生存率（DFS）明显高于单纯行肝切除术（H-O 组）的患者。H-S 组、H-preS 组和 H-O 组患者的 1、3 和 5 年 DFS 率分别为 74.6%、48.4%、39.8%和 80.1%、54.2%、40.1%和 60.5%、30.3%、13.3%。肿瘤大小、肿瘤数量和甲胎蛋白（AFP）水平是 DFS 的独立危险因素。性别和肿瘤大小是总生存率（OS）的独立预后因素。H-preS 组患者术前白细胞（WBC）和血小板（PLT）计数明显高于 H-S 组和 H-O 组。术后 H-S 组和 H-preS 组的 WBC 和 PLT 计数明显高于 H-O 组。
无论行脾切除术还是同期行肝切除术和脾切除术，肝切除术联合脾切除术均可提高 HCC 和脾功能亢进患者的 DFS 率，而行脾切除术可缓解脾功能亢进，且不增加手术风险。
