肝癌合并肝硬化脾功能亢进患者同期行肝脾脏联合切除的临床疗效观察  

Study of the Clinical Effects of Concomitant Splenectomy in Patients with Hepatocellular Carcinoma Accompanied with Cirrhosis and Hypersplenia

作　　者：蔡建强[1] 毕新宇[1] 胡敬群[1] 赵建军[1] 杨晓洁[1] 邵永孚[1] 赵平[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院腹部肿瘤外科,100021

出　　处：《实用癌症杂志》2003年第3期277-279,共3页The Practical Journal of Cancer

摘　　要：目的　探讨肝癌合并肝硬化、脾功能亢进患者同期行肝脾脏联合切除的临床疗效。方法　自 1999年 12月至 2 0 0 2年3月 ,中国医学科学院肿瘤医院共收治合并肝硬化脾功能亢进原发性肝癌患者 67例 ,其中 38例行肝脾联合切除术 (切脾组 ) ,2 9例仅行肝癌切除术 (非切脾组 )。对 2组的临床资料及术前 1天、术后 7天外周静脉血及脾静脉血中血管内皮生长因子 (VEGF)的浓度进行比较。结果　切脾组血小板及白细胞术后回升明显好于非切脾组 (P <0 .0 5 )。术后并发症发生率 :切脾组 2 8.9% ( 11/ 38)、非切脾组 2 0 .6% ( 6/ 2 9) ;1年复发转移率 :切脾组 2 1.1% ( 8/ 38)、非切脾组 2 0 .7% ( 6/ 2 9) ,2组并发症发生率及 1年复发率相比较 ,均无显著性差异 (P >0 .0 5 )。 2组术前、术后外周血及术中脾静脉血中的VEGF浓度相比较亦无显著性差异 (P >0 .0 5 )。切脾组2 9例患者术后均顺利地接受了 1～ 3次介入化疗 ,而非切脾组则因为血像过低有 7例患者被迫终止了介入化疗。结论　切脾组患者 ,在术后血像回升及接受介入化疗方面明显好于非切脾组 ,而Objective To discuss the clinical effects of concomitant splenectomy in hepatocellular carcinoma patients accompanied with cirrhosis and hypersplenia.Methods 67 patients who had hepatocellular carcinoma(HCC) accompanied with hypersplenia from December 1999 to March 2002 were reviewed retrospectively.38 Patients underwent liver and spleen united resection(splenectomy group),29 Patients only received hepatectomy(non-splenectomy group).1 day before operation and 7 days after operation,the concentration of vascular endothelium growth factor(VEGF) in peripheral blood and spleen venous blood were compared between two groups.Results The increase of PLT and WBC was significantly higher in patients who underwent concomitant splenectomy than in patients who kept spleen(P<0.05).The occurrence of complication was 28.9%(11/38)in splenectomy group and 20.6%(6/29) in non-splenectomy group,and the recurrence rate one year later was 21.1%(8/38)in splenectomy group and 20.7%(6/29) in non-splenectomy group.There was no significant difference in complication occurrence and reccurrence rate between two groups.The concentration of VEGF was not significantly differenert between in peripheral blood and in spleen venous blood.29 patients in splenectomy group received hepatic arterial chemoembolization 1～3 times successfully after operation,but in non-splenectomy group there were 7 patients had to stop the successive treatment because the PLT and WBC were too low.Conclusion Combined Splenectomy is helpful to raise PLT and WBC and enable patients to receive subsequent chemoembolization.Early recurrence and metastasis are not significantly different between patients with and without splenectomy.

关 键 词：肝癌 合并症 肝硬化 脾功能亢进 肝脾脏联合切除术 临床疗效 血管内皮生长因子 

分 类 号：R735.7[医药卫生—肿瘤] R730.56[医药卫生—临床医学]