Wang Xishu, Sun Ximin, Lei Yongrong, Pei Jun, Ma Kuansheng, Feng Kai, Lau Wan Yee, Xia Feng
Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China.
Hygienic Company of 65529 Troops of PLA, Liaoyang, Liaoning, China.
J Invest Surg. 2023 Dec;36(1):1-7. doi: 10.1080/08941939.2022.2130482.
To compare the short- and long-term treatment outcomes of open radiofrequency ablation combined with splenectomy and pericardial devascularization versus liver transplantation for hepatocellular carcinoma patients with portal hypertension and hypersplenism.
During the study period, the treatment outcomes of consecutive HCC patients with portal hypertension and hypersplenism who underwent open radiofrequency ablation, splenectomy and pericardial devascularization (the study group) were compared with the treatment outcomes of a case-matched control group of HCC patients who underwent liver transplantation.
The study group consisted of 32 patients, and the control group comprised 32 patients selected from 155 patients who were case-matched by tumor size, age, gender, MELD sore, tumor location, TNM classification, degree of splenomegaly and Child-Pugh staging. Baseline data on preoperative laboratory tests and tumor characteristics were comparable between the two groups. The mean follow-up was 43.2 ± 5.3 months and 44.9 ± 5.8 months for the study and control groups, respectively. Although the disease-free survival rates of the control group were better than those of the study group ( < 0.001), there was no significant difference in the cumulative overall survival time or the incidence of portal vein thrombosis between the two groups ( = 0.670, 0.083). Compared with the control group, the study group had significantly less intraoperative blood loss, and lower incidences of postoperative pleural effusion and pneumonia (all < 0.05).
Open radiofrequency ablation, splenectomy and pericardial devascularization for small HCCs with portal hypertension and hypersplenism can be an alternative therapy for a subset of carefully selected patients under the shortage of liver donors.
比较开放性射频消融联合脾切除术和心包去血管化与肝移植治疗门静脉高压和脾功能亢进的肝细胞癌患者的短期和长期治疗效果。
在研究期间，将连续接受开放性射频消融、脾切除术和心包去血管化的门静脉高压和脾功能亢进的肝癌患者（研究组）的治疗效果与接受肝移植的肝癌患者病例匹配对照组的治疗效果进行比较。
研究组由32例患者组成，对照组由从155例患者中选出的32例患者组成，这些患者在肿瘤大小、年龄、性别、终末期肝病模型（MELD）评分、肿瘤位置、TNM分类、脾肿大程度和Child-Pugh分期方面进行了病例匹配。两组术前实验室检查和肿瘤特征的基线数据具有可比性。研究组和对照组的平均随访时间分别为43.2±5.3个月和44.9±5.8个月。虽然对照组的无病生存率优于研究组（<0.001），但两组的累积总生存时间或门静脉血栓形成发生率无显著差异（=0.670，0.083）。与对照组相比，研究组术中失血量显著减少，术后胸腔积液和肺炎的发生率较低（均<0.05）。
对于门静脉高压和脾功能亢进的小肝癌，开放性射频消融、脾切除术和心包去血管化可作为在肝供体短缺情况下部分精心挑选患者的替代治疗方法。
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