肝癌切除联合脾脏微波消融治疗合并脾功能亢进肝癌患者的临床观察  

Hepatecotomy combined with microwave ablation of spleen for treatment of liver cancer complicated with hypersplenism

作　　者：韩建波[1] 易永祥[1] 魏强[2] 刘俊卯[1] 赵亮[1] 

机构地区：[1]南京市第二医院普通外科,江苏南京210003 [2]南京市第二医院超声诊断科,江苏南京210003

出　　处：《中华肿瘤防治杂志》2013年第13期1007-1010,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：南京市医学科技发展课题(YKK10057);江苏省六大人才高峰项目(2010-WS-060)

摘　　要：目的:探讨肝癌切除联合脾脏微波消融治疗肝癌合并脾肿大脾功能亢进的临床安全性及中期疗效。方法:回顾分析我院13例肝炎肝硬化后脾功能亢进合并肝癌行肝癌切除联合脾脏微波消融患者的临床资料。结果:脾脏毁损体积占脾脏总体积比例的(34.20±1.72)%。谷丙转氨酶和谷草转氨酶术后第1天明显升高,P值分别为0.039和0.001;术后1周内逐渐恢复至正常或术前水平,P值分别为0.222和0.303。总胆红素术后第1天较术前轻度升高,白蛋白和胆碱酯酶较术前轻度降低,但3者与术前比较差异均无统计学意义,P值分别为0.069、0.073和0.066;术后1周内逐渐恢复正常或术前水平。白细胞术后第1天升高明显,之后轻度下降,术后1、2周和1、3、6个月较术前均升高,P值分别为0.001、0.001、0.028、0.037和0.034。血小板术后第1天、术后1周较术前升高不明显,P值分别为0.908和0.274;术后2周升高显著,P=0.005;术后1、3和6个月较术前均明显升高,差异有统计学意义,P值分别为0.012、0.016和0.020。所有患者均完成治疗,顺利出院,未发生肝功能衰竭、肝肾综合征、肝性脑病、肝断面大量渗血、上消化道出血、脾脓肿、脾脏破裂、顽固性腹水、顽固性疼痛以及门静脉血栓等严重并发症;术后随访6个月未见死亡及肿瘤复发病例,未见上消化道出血及肝功能衰竭病例。结论:肝癌切除联合脾脏微波消融治疗肝癌合并脾肿大脾功能亢进手术安全,中期疗效显著。OBJECTIVE：To investigate the security and curative effect of hepatecotomy combined with microwave ablation of spleen for treatment of splenomegaly and hypersplenism complicated with liver cancer. METHODS：Retrospec- tively analysis of clinical characteristics of thirteen patients treated with microwave ablation of spleen combined with hep- atecotomy for hypersplenism secondary to hepatitis cirrhosis complicated with liver cancer. RESULTS： The proportion of the destructed volume to the total spleen volume was （34.20 ±1.72）%; Alanine aminatransferase and aspartate amin- otransferase increased in the first day after operation（P=0. 039 ;P=0. 001） ,and recovered to normal or baseline level in one week （P= 0. 222;P = 0. 303）. Total bilirubin increased slightly, albumin and cholinesterase decreased mildly in the first day,and no statistically significant difference was found compared with the preoperative, and P were 0. 069,0. 073 and 0. 066 ;The count of white blood cell increased in the first day after operation,and then decreased slightly,and it was still higher compared with preoperative after one week,two week,one month,two month,six month later,P were 0. 001, 0. 001,0. 028,0. 037 and 0. 034;The count of blood platelet increased not significantly in the first day and one week after operation（P = 0. 908;P = 0. 274） but it increased significantly two weeks later（P = 0. 005）, it also increased significantly after one month, two month, six month later compared with preoperative（P were 0. 012,0. 016 and 0. 020）. All of the thir- teen patients completed the treatment,and recovered successfully;No severe complications such as liver failure, hepatore- nal syndrome, hepatic encephalopathy, liver section errhysis, upper gastrointestinal bleeding, spleen abscess, spleenrupture, refractory ascites,intractable pain rence case was found in the postoperative was found too. CONCLUSION ： Hepatecoto hypersplenism complicated with liver canc and portal vein thrombosis developed after operation. No dea

关 键 词：肝肿瘤 外科学 微波消融 脾功能亢进 脾肿大 疗效 回顾性研究 

分 类 号：R735.7[医药卫生—肿瘤]