不同手术方法治疗伴有脾功能亢进症的原发性肝癌患者临床疗效研究  

Splenic management in patients with primary liver cancer underwent hepatectomy

作　　者：贺爱军[1] 任羽[1] 

机构地区：[1]延安大学附属医院普通外科,陕西省延安市716000

出　　处：《实用肝脏病杂志》2017年第5期571-574,共4页Journal of Practical Hepatology

摘　　要：目的探讨脾脏处理对行肝癌切除术的原发性肝癌(PLC)患者临床疗效的影响。方法 2006年1月~2016年1月在我院接受治疗的140例PLC患者,A组46例行肝癌切除术联合脾切除术,B组34例行肝癌切除术/脾切除术/贲门周围血管离断术,C组30例行肝癌切除术联合脾动脉结扎术,D组30例行肝癌切除术。结果治疗后C、D组患者血小板计数(PLT)为【(215.4±118.9)×10~9/L和(176.4±105.5)×10~9/L】,白细胞(WBC)计数为【(3.36±1.23)×10~9/L和(2.36±1.21)×10~9/L】,均显著低于A、B组(P均<0.05);术后D组患者总胆红素(TBIL)水平为(37.7±5.1)μmol/L,明显高于A组或B组或C组(P均<0.05);治疗后D组患者CD4+细胞为(28.3±5.9)%,CD4+/CD8+比值为(1.3±0.3)%,均明显低于A、B、C组(P均<0.05);D组患者术后并发症发生率为33.3%,明显高于A组的17.4%、B组的23.5%和C组的20.0%(P<0.05)。结论行脾处理可以有效改善行肝癌切除术治疗的PLC患者术后肝功能和免疫功能,减少并发症。Objective The study was aimed to analyze the clinical implications of splenic management in patients with primary liver cancer underwent hepateetomy. Methods Clinical data of 140 patients with primary liver cancer with underlying liver cirrhosis and hypersplenia between January,2006 and January,2016 was retrospectively analyzed. 46 patients in group A received hepatectomy and splenectomy,34 in group B received hepatectomy and splenectomy and pericardia vascular disconnection,30 in group C received hepatectomy and ligation of splenic artery,and 30 in group D received hepatectomy alone. Results The general materials,operation time,intraoperative blood loss,intraoperative blood transfusion volume in four groups had no statistical difference （P〉0.05）;two weeks after treatment,blood PLT and WBC counts in group C were [（215.4±118.9）×109/L and （3.36±1.23）x×109/L,in group D were [（176.4±105.5）×109/L and（2.36±1.21）×109/L,much lower than those in group A [（366.8±l18.7）×109/L and（7.52±l.18）×109/L],or in group B [（372.6±l19.8）×109/L and （7.54±1.19）×109/L,P〈 0.05];serum TBIL,AST and ALT levels in group D were [（37.7±5.1） Ixmol/L,（65.8±9.2）U/L and （75.8±10.1） U/L, much higher than those in group A [（24.8±4.8） μmol/L,（44.7±10.9）U/L and （50.1±12.2）U/L],or in group B [-（25.5±5.0）μmol/L,（45.8±9.9）U/L and （51.3±12.8） U/L],or in group C [（24.4±5.0）μmol/L,（45.3±9.5）U/L and （50.4±11.8） U/L,P〈0.05];the percentage of CD4＋ cells and CD4＋/CD8＋ ratio in group D were [（28.3±5.9）% and （1.3±0.3）],obviously lower than those in group A [（44.1±5.9）% and （2.0±0.2）3,or in group B [（43.5±6.8）% and （2.0±0.3）],or in group C [（39.2±6.8）% and（1.9±0.2）],and the percentage of CD8＋ cells in group D was （30.3~ 7.8）%,obviously higher than those in group A（22.0±6.9）%,or in group B（22.4±6.5）%,or in group C（21.8±7.0）% （P〈0.05）;the complication occurrence in group D was

关 键 词：原发性肝癌 脾功能亢进症 肝癌切除术 脾切除术 贲门周围血管离断术 脾动脉结扎术 

分 类 号：R735.7[医药卫生—肿瘤]