论文部分内容阅读
目的:探讨肝脾联合切除术与常规肝切除术治疗肝癌合并脾功能亢进患者肿瘤学效果及风险比较，为临床应用提供指导。方法:采用回顾性病例对照研究，选取浙江省义乌復元私立医院2012年4月至2014年8月收治的符合研究要求的118例肝癌合并脾功能亢进患者，根据手术方式不同将其分为两组，行肝脾联合切除术者为联合组，行常规肝切除术者为对照组，各59例。比较两组患者手术情况、血常规、肝功能、术后并发症、肿瘤效应（局部复发、远处转移、术后1、3和5年生存率）。结果:两组患者手术时间、术中出血量、住院时间比较差异无统计学意义（n P>0.05）；与对照组比较，联合组患者临床总有效率显著升高[94.92%（56/59）比79.66%（47/59）]（n P0.05）；两组患者均随访至2019年8月1日，联合组患者的中位生存期显著高于对照组（29个月比22个月）（n P<0.05）；两组患者局部复发、远处转移率、1、3和5年生存率比较差异有统计学意义（n P<0.05）；联合组术后第7天血小板、白细胞明显高于对照组[（264.48 ± 75.37） × 10n 9/L比（153.53 ± 42.11） × 10n 9/L、（7.86 ± 1.43） × 10n 9/L比（3.48 ± 1.32） × 10n 9/L]（n P<0.05）；联合组术后第7天时丙氨酸氨基转移酶、天冬氨酸氨基转移酶与对照组比较均显著降低[（49.42 ± 31.88） U/L比（84.22 ± 43.95） U/L、（36.50 ± 21.50） U/L比 （49.98 ± 35.63） U/L]（n P0.05). Compared with that of the control group, the clinical total effective rate of the combined group was significantly increased: 94.92% (56/59) vs. 79.66% (47/59),n P0.05); the two groups were followed up to August 1, 2019. The median survival time of the two groups was significantly higher than that of the open group (29 months vs 22 months) (n P<0.05); the local recurrence rate, distant metastasis rate, 1, 3 and 5-year survival rate between the two groups were statistically significant (n P<0.05). The platelet and white blood cells in the combined group were significantly higher than those in the control group after 7 days′ treatment: (264.48 ± 75.37) × 10n 9/L vs. (153.53 ± 42.11) × 10n 9/L, (7.86 ± 1.43) × 10n 9/L vs. (3.48 ± 1.32) × 10n 9/L, n P<0.05. Compared with that of the control group, alanine aminotransferase and aspartate aminotransferase were significantly decreased: (49.42 ± 31.88) U/L vs. (84.22 ± 43.95) U/L, (36.50 ± 21.50) U/L vs. (49.98 ± 35.63) U/L,n P<0.05.n Conclusions:Compared with conventional hepatectomy for hepatocellular carcinoma patients with hypersplenism, combined hepatosplenectomy can effectively promote the increase of peripheral blood PLT and WBC and the recovery of liver function without increasing the risk of surgery, and the long-term follow-up results are more satisfactory, which has high clinical application value.