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目的探讨肝细胞癌合并脾功能亢进患者同期行肝癌切除和脾切除的安全性及可行性。方法回顾性分析2001年11月至2012年4月期间笔者所在医院收治的52例肝细胞癌合并脾功能亢进同期施行肝癌切除和脾切除患者的临床资料。结果肝癌切除联合脾切除19例,肝癌切除联合脾切除加贲门周围血管离断术33例。手术时间(249.63±40.90)min(182~340 min),术中出血量(580.77±260.31)mL(200~1 700)mL。全组无死亡病例,术后并发症包括:胸腔积液11例,肺内感染3例,肝断面感染3例,胆汁漏1例,切口感染2例,高胆红素血症3例,门静脉系统血栓形成22例,均经保守治疗后好转。术后第14天,患者的白细胞和血小板计数分别由术前的(3.19±1.59)×109/L和(53.96±18.94)×109/L升至(8.86±5.06)×109/L和(464.90±189.27)×109/L(P<0.05);术后红细胞计数变化不明显,甚至有轻度下降。结论对于肝细胞癌合并脾功能亢进患者,选择合适的病例同期行肝癌切除和脾切除是安全可行的,而且脾切除有助于缓解脾功能亢进。
Objective To investigate the safety and feasibility of hepatectomy and splenectomy in patients with hepatocellular carcinoma complicated with hypersplenism over the same period. Methods The clinical data of 52 patients with hepatocellular carcinoma complicated with hypersplenism treated by HCC and splenectomy during the same period from November 2001 to April 2012 were retrospectively analyzed. Results 19 cases of hepatectomy combined with splenectomy, hepatectomy combined with splenectomy plus pericardial vascular disconnection in 33 cases. The operative time (249.63 ± 40.90) min (182 ~ 340 min) and the intraoperative blood loss (580.77 ± 260.31) mL (200 ~ 1 700) mL. There were no deaths in the whole group. Complications included 11 cases of pleural effusion, 3 cases of pulmonary infection, 3 cases of hepatic section infection, 1 case of bile leakage, 2 cases of incisional infection, 3 cases of hyperbilirubinemia, 3 cases of portal vein Systemic thrombosis in 22 cases, after conservative treatment improved. On the 14th postoperative day, the white blood cell count and platelet count increased from (3.19 ± 1.59) × 109 / L and (53.96 ± 18.94) × 109 / L to (8.86 ± 5.06) × 109 / L and ± 189.27) × 109 / L (P <0.05). The change of erythrocyte count was not obvious or even slightly decreased after operation. Conclusion For hepatocellular carcinoma patients with hypersplenism, it is safe and feasible to select the appropriate cases for resection of liver cancer and splenectomy in the same period, and splenectomy can help to relieve hypersplenism.