微波凝固坏死疗法联合腹腔镜脾切除术治疗原发性肝癌合并脾功能亢进的效果观察  

Clinical effect on microwave coagulo-necrotic therapy combined with laparoscopic splenectomy in treatment of primary hepatocellular carcinoma complicated by hypersplenism

作　　者：刘曙民 孙邱 张美菊[2] LIU Shumin;SUN Qiu;ZHANG Meiju(Department of Interventional Radiology,Baoji Municipal People′s Hospital,Baoji,Shaanxi 721000,China)

机构地区：[1]宝鸡市人民医院介入科,陕西宝鸡721000 [2]宝鸡市第二人民医院肿瘤科,陕西宝鸡721000

出　　处：《临床肝胆病杂志》2018年第1期142-146,共5页Journal of Clinical Hepatology

摘　　要：目的探讨微波凝固坏死疗法(MCN)和腹腔镜脾切除术(LS)联合治疗原发性肝癌(PHC)合并脾功能亢进患者的可行性及安全性。方法回顾性分析2008年1月-2012年12月宝鸡市人民医院收治的MCN和LS联合治疗的PHC合并脾功能亢进患者22例。收集患者临床资料,观察患者术后并发症及生存情况。计量资料比较采用t检验,累积生存曲线采用Kaplan-Meier法绘制。结果 MCN治疗中5例经胸廓切开术、15例经剖腹术、2例经腹腔镜术,LS治疗中17例采用手辅助LS、5例行单纯LS。平均手术时间(303.24±56.02)min,平均失血量(146.92±60.72)ml,平均切除脾脏重量(670.42±204.54)g。22例患者术后6例(27.27%)发病、5例(22.73%)门静脉血栓形成、2例(9.09%)存在胸腔积液。术后1个月血小板计数较术前显著升高[(15.72±5.47)×10~4/μl vs(4.43±1.03)×10~4/μl,t=6.83,P<0.001]。术后1、3、5年总生存率分别为90.91%、68.18%、59.09%,术后1、3、5年无病生存率分别为59.09%、13.64%、13.64%。结论 MCN和LS联合治疗PHC合并脾功能亢进患者安全、有效、可行。Objective To investigate the feasibility and safety of microwave coagulo-necrotic therapy(MCN)combined with laparoscopic splenectomy(LS)in the treatment of primary hepatocellular carcinoma(PHC)complicated by hypersplenism.Methods A retrospective analysis was performed for the clinical data of 22 PHC patients with hypersplenism who were admitted to Baoji Municipal People′s Hospital from January 2008 to December 2012 and underwent MCN combined with LS.Their clinical data were collected,and postoperative complications and survival were observed.The t-test was used for comparison of continuous data,and the Kaplan-Meier method was used to plot cumulative survival curves.Results In MCN therapy,5 patients underwent thoracotomy,15 underwent laparotomy,and 2 underwent laparoscopic surgery;in LS treatment,17 underwent hand-assisted LS and 5 underwent simple LS.The mean time of operation was(303.24±56.02)min,the mean blood loss volume was(146.92±60.72)ml,and the mean weight of the resected spleen was(670.42±204.54)g.Of all patients,6(27.27%)experienced postoperative recurrence,5(22.73%)experienced portal vein thrombosis,and 2(9.09%)experienced pleural effusion.There was a significant increase in platelet count at 1 month after surgery[(15.72±5.47)×10^4/μl vs(4.43±1.03)×10^4/μl,t=6.83,P<0.001].The 1-,3-,and 5-year overall survival rates after surgery were 90.91%,68.18%,and 59.09%,respectively,and the 1-,3-,and 5-year disease-free survival rates were 59.09%,13.64%,and 13.64%,respectively.Conclusion MCN combined with LS is safe,effective,and feasible in the treatment of PHC complicated by hypersplenism.

关 键 词：肝肿瘤 脾功能亢进 导管消融术 脾切除术 治疗结果 

分 类 号：R735.7[医药卫生—肿瘤]