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目的探讨不同方法治疗肝癌合并脾功能亢进患者的临床疗效和意义。方法回顾性分析2007～2010年收治的63例肝癌合并脾功能亢进患者的临床资料,其中,26例行单纯肝癌切除术(Ⅰ组),18例行肝切除同时联合脾切除或脾动脉结扎(Ⅱ组),19例行术前部分性脾栓塞(partial splenic embolization,PSE)联合肝切除(Ⅲ组)。观察3组治疗前后外周血细胞变化情况,分析围术期出血、输血和并发症等情况,比较各组1、3年总生存率。结果联合手术组术后外周血白细胞、血小板均较单纯手术组明显改善,与术前PSE组无明显差异。术前PSE组患者出血量和输血量均较Ⅱ组和Ⅰ组明显减少(P<0.05)。联合手术组和术前PSE组的术后并发症明显低于单纯手术组患者,Ⅰ、Ⅱ和Ⅲ组患者1、3年总生存率分别为:68.5%、38.1%,82.8%、52.6%和85.5%、56.3%,Ⅰ组患者显著低于Ⅱ组和Ⅲ组(P<0.05)。结论肝脾联合手术和术前PSE是治疗肝癌合并脾功能亢进安全、有效的方法。术前PSE治疗更适合严重的门脉高压、巨脾、老龄和体质差患者。
Objective To investigate the clinical efficacy and significance of different methods in the treatment of patients with liver cancer complicated with hypersplenism. Methods The clinical data of 63 patients with hepatocellular carcinoma complicated with hypersplenism admitted from 2007 to 2010 were analyzed retrospectively. Among them, 26 patients underwent simple hepatectomy (group Ⅰ), 18 underwent hepatectomy combined with splenectomy or splenic artery ligation Group Ⅱ). Nineteen patients underwent preoperative partial splenic embolization (PSE) combined with hepatectomy (group Ⅲ). The changes of peripheral blood cells in 3 groups before and after treatment were observed. The perioperative bleeding, blood transfusion and complication were analyzed. The 1 and 3-year overall survival rate of each group was compared. Results The postoperative peripheral blood leucocytes and platelets in the operation group were significantly improved compared with those in the operation alone group. There was no significant difference between preoperative PSE group and the operation group. Preoperative PSE group patients with blood loss and blood transfusion were significantly less than the group Ⅱ and Ⅰ (P <0.05). The postoperative complications in the combined surgery group and the preoperative PSE group were significantly lower than those in the simple surgery group. The overall 1,3 and 3-year overall survival rates were 68.5%, 38.1%, 82.8% and 52.6% respectively in the groups Ⅰ, Ⅱ and Ⅲ 85.5% and 56.3% respectively. The patients in group Ⅰ were significantly lower than those in groups Ⅱ and Ⅲ (P <0.05). Conclusions The combined operation of liver and spleen and preoperative PSE is a safe and effective method for the treatment of liver cancer complicated with hypersplenism. Preoperative PSE treatment is more suitable for severe portal hypertension, splenomegaly, aging and poor physical fitness.