腹腔镜肝癌切除术联合脾脏切除对肝癌合并脾功能亢进的早期效果分析  

Early effect of laparoscopic hepatectomy combined with splenectomy on hepatocellular carcinoma with hypersplenism

作　　者：邹卫华 唐勇[2] Zou Weihua;Tang Yong(Department of Hepatobiliary surgery,the first people’s Hospital of Jiangxia District,Wuhan City Wuhan,Hubei 430200;Department of Hepatobiliary surgery,Union Hospital affiliated to Huazhong University of Science and Technology Wuhan,Hubei 430000)

机构地区：[1]武汉市江夏区第一人民医院肝胆外科,武汉430200 [2]华中科技大学附属协和医院肝胆外科,武汉430000

出　　处：《中华普外科手术学杂志（电子版）》2020年第5期483-486,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2017年湖北省知识创新专项(自然科学基金)(2017CFB788)。

摘　　要：目的探讨腹腔镜肝癌切除术联合脾脏切除对肝癌合并脾功能亢进的早期疗效。方法回顾性分析2016年1月至2019年5月接受腹腔镜手术治疗的54例肝癌合并脾功能亢进患者临床资料。将肝癌切除同时行脾脏切除者纳入切脾组(25例),仅行肝癌切除术保留脾脏者纳入保脾组(29例)。临床数据使用统计学软件SPSS 24.0分析,术中术后各项指标、肝功能及免疫指标采用(±s)表示,独立样本t检验;术后并发症等组间比较采用χ2检验。P<0.05为检验标准。结果两组患者均成功完成手术,无中转开腹。切脾组手术时间明显较保脾组更长(P=0.003),术中出血量及术后住院时间差异无统计学意义(P>0.05)。术后1周,两组患者外周血WBC、PLT均较术前明显升高,且切脾组显著高于保脾组(P<0.05);两组患者肝功能指标ALT、AST、Tbil均较术前明显升高,保脾组较切脾组更高(P<0.05);术后免疫功能指标切脾组CD4、CD4/CD8显著升高,而CD8显著降低,且明显优于保脾组(P<0.05)。切脾组及保脾组患者早期并发症发生率分别为16.0%及17.2%,两组间差异无统计学意义(P>0.05)。结论腹腔镜肝癌切除联合脾脏切除治疗肝癌合并脾功能亢进安全可行,降低了手术创伤,早期疗效满意。Objective To investigate the early effect of laparoscopic hepatectomy combined with splenectomy on hepatocellular carcinoma with hypersplenism.Methods The clinical data of 54 patients of hepatocellular carcinoma with hypersplenism treated by laparoscopic surgery in our hospital were retrospectively analyzed.The patients who underwent liver cancer resection and splenectomy were included in splenectomy group,while those who underwent liver cancer resection and spleen preservation were included in spleen preserving group.The data were analyzed by SPSS24.0 statistical software,Among them,the number of complications and other counting data were expressed by n(%),and the results were compared withχ2.The measurement data such as Perioperative indexes、peripheral blood indexes were expressed in(±s),and compared with Independent sample t test and paired t test,P<0.05 was considered statistically significant.Results The operation was successfully completed in both groups without conversion to laparotomy.There were significant differences in operation time between the two groups(P=0.003),and no significant difference in intraoperative blood loss and postoperative hospital stay(P>0.05).The changes of WBC,PLT,liver function and immune function in peripheral blood of the two groups before and one week after operation were compared.There was no significant difference in preoperative indexes(P>0.05).One week after operation,WBC and PLT in peripheral blood of the two groups were significantly higher than those before operation,and splenectomy group were significantly higher than those of spleen preserving group(P<0.05);ALT,AST and Tbil in the two groups were significantly higher than those before operation,while those in spleen preserving group were more significant than those in splenectomy group(P<0.05);CD4,CD4/CD8 in the immune function were not significantly changed after operation in spleen preserving group(P>0.05);CD4,CD4/CD8 in splenectomy group were not significant changes after operation(P>0.05).It was significantly h

关 键 词：肝肿瘤 脾切除术 脾功能亢进 

分 类 号：R735.7[医药卫生—肿瘤]