肝癌切除联合脾切除治疗合并门静脉高压症的巴塞罗那A期肝癌  

Hepatectomy combined with splenectomy in patients with hepatocellular carcinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension

作　　者：徐教邦[1] 刘巧云[1] 潘国政[1] 王希超[1] 张建[1] 朱瑞[1] 袁庆忠[1] 

机构地区：[1]胜利油田中心医院肝胆外科,山东东营257034

出　　处：《中华肝胆外科杂志》2017年第6期365-369,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝癌切除联合脾切除术治疗合并门静脉高压症的巴塞罗那A期肝癌的安全性及其对患者生存期的影响。方法回顾性分析2008年7月至2015年6月胜利油田中心医院收治的合并门静脉高压症的巴塞罗那A期肝癌患者临床资料。根据手术方式将患者分为研究组（肝癌切除联合脾切除，n=51）与对照组（单纯肝癌切除，n=66）。比较两组患者手术时间、术中出血量、肝门阻断时间、术后肝功能、PLT水平、HBV激活情况、引流管拔除时间、并发症发生情况、术后上消化道出血以及患者生存期。结果（1）研究组手术时间、术中出血量、术后1周及1个月PLT均高于对照组，分别为（161．4±38．3）min比（119．2±36．4）min、（268．7±72．1）ml比（201．3±61．3）ml、（189．2±51．3）×10^9／L比（81．9±32．2）×10^9／L、（327．4±69．1）×10^9／L比（84．5±28．5）×10^9／L（均P〈0．05）。两组患者引流管拔除时间、肝门阻断时间、肿瘤切缘距离、TBil、并发症发生率及上消化道出血发生率差异无统计学意义（均P〉0．05）。术后研究组HBV激活率、ALT、AST低于对照组，分另0为3．9％（2／51）比18．2％（12／66）、（45．7±11．4）U／L比（58．3±14．7）U／L、（48．1±12．4）U／L（61．3±15．1）U／L（均P〈0．05）。（2）研究组与对照组1、3、5年无复发生存率分别为84．3％、34．1％、27．3％比78．8％、42．1％、9．7％（均P〉0．05），1、3、5年总体生存率分别为94．1％、66．3％、33．5％比90．9％、46．7％、16．1％（均P〈0．05）。结论肝癌切除联合脾切除在保证围手术期安全性情况下，可降低患者术后HBV激活率并改善患者总体生存期。Objective To evaluate the peri-operative and survival outcomes of hepatectomy com- bined with splenectomy in patients with hepatocellular carcinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension. Methods We retrospectively analyzed the data on patients with hepatocellular car- cinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension who underwent surgery at the Shengli Oilfield Central Hospital between July 2008 and June 2015. According to the operative method, the patients were classified as the experimental group （hepateetomy combined with splenectomy） and the control group （hepateetomy）. We compared and analyzed the clinical data between these two groups, which inclu- ded the operation time, blood loss, duration of hepatic portal occlusion, width of surgical resection margin, liver function, PLT, HBV reactivation, time to remove drainage tube, complications, upper gastrointestinal hemorrhage rate and survival outcomes. Results （ 1 ） The operation time, blood loss, PLT at 1 week and 1 month after surgery in the experimental group were all significantly higher than the control group [ （ 161.4 ± 38.3） min vs. （119.2±36.4） min, （268.7±72. 1） vs. （201.3 ±61.3） ml, （189.2 ±51.3）× 109/L vs. （81.9±32.2） × 109/L, （327.4±69. 1）×109/L vs. （84.5 ±28.5）×109/L （all P〈0.05）, respectively ]. The time to remove drainage tube, duration of hepatic portal occlusion, width of resection surgical margin, TBil, complications and upper gastrointestinal hemorrhage rates of the two groups were not significantly different （ all P 〉 0.05 ）. The HBV reactivation rate, ALT and AST in the experimental group were significantly lower than the control group [3.9% （2/51） vs. 18.2% （12/66） , （45. 7 ± 11.4） U/L vs. （58.3±14.7） U/L, （48.1±12.4） U/Lvs. （61.3±15.1） U/L （allP〈0.05）, respectively]. （2） The 1, 3 and 5-year recurrence free survival rates were not significantly different between the experimental an

关 键 词：肝细胞肝癌 巴塞罗那分期 门静脉高压 脾切除 

分 类 号：R735.7[医药卫生—肿瘤]