射频消融联合脾切除治疗肝癌合并肝硬化脾功能亢进的疗效

摘要

目的 探究射频消融联合脾切除手术治疗原发性肝癌合并肝硬化脾功能亢进的效果.方法 选取2016年1月至2017年12月在阜阳市人民医院收治的30例肝癌合并肝硬化脾功能亢进患者作为研究对象.患者随机分为观察组(n=15)和对照组(n=15).观察组行射频消融联合脾切除治疗,对照组采用肝肿瘤手术切除联合脾切除治疗.比较两组患者术中一般指标、术后1周血小板水平、肝功能情况以及术后2年内并发症发生情况、生存率等.结果 观察组和对照组手术时间为(89.1±18.4比118.9±33.6)min,住院时间为(13.5±6.0比21.9±11.6)d,术中失血量为(228.4± 120.5比362.2±159.5) ml,输血量为(192.3±112.4比503.8±196.2)ml,差异均具有统计学意义(均P＜0.05).术后1周,观察组各项指标均明显优于对照组(均P＜0.05).术后2年内观察组并发症发生率13.3％,显著低于对照组的46.7％(P＜0.05).术后2年两组患者的生存率差异无统计学意义(P＞0.05).结论 射频消融联合脾切除治疗肝癌合并肝硬化脾功能亢进,可有效减少术后并发症,保护肝功能,提高血小板水平,改善脾功能亢进且安全性高,是临床值得推广的手术方式.%Objective To study the efficacy and safety of radiofrequency ablation combined with splenectomy in treatment of primary liver cancer with liver cirrhosis and hypersplenism.Methods Thirty patients with hepatocellular carcinoma complicated with liver cirrhosis and hypersplenism were treated in Fuyang People's Hospital from January 2016 to December 2017.These patients were randomly divided into the observation group (n =15) and the control group (n =15).Surgical liver resection combined with splenectomy was performed in the control group,and radiofrequency ablation combined with splenectomy was performed in the observation group.The time of thermal ischemia,operation time,intraoperative blood loss,blood transfusion volume,length of hospital stay,platelet level and liver function 1 week after surgery,and the incidences of postoperative complications and the overall survival rates 2 years after surgery were compared between the two groups.Results The operation times of the observation group and the control group were (89.1 ± 18.4 vs.118.9 ± 33.6) rin,blood loss (228.4 ± 120.5 vs.362.2 ± 159.5) ml,blood transfusion (192.3±112.4 vs.503.8±196.2) ml,and length of hospital stay (13.5±6.0 vs.21.9±11.6) d (all P＜0.05).After a week of operation,the indicators in the observation group were significantly better than the control group (all P＜0.05).The postoperative two-years complication rate in the observation group was 13.3％,which was significantly lower than the control group (46.7％,P＜0.05).There was no significant difference in the survival rates between the two groups two years after surgery.Conclusions Radiofrequency ablation combined with splenectomy for treatment of liver cancer with cirrhosis and hypersplenism effectively reduced postoperative complications,preserved liver function,increased platelet levels,improved hypersplenism,and was safer.It is a surgical method worthy of generalization.