肝癌合并肝硬化脾功能亢进的围手术期处理

摘要

目的 探讨肝癌联合脾切除对原发性肝癌合并肝硬化脾功能亢进患者手术安全性的影响以及围手术期处理原则.方法 回顾性分析1999年1月至2009年12月收治的177例原发性肝癌合并肝硬化脾功能亢进患者的临床资料,男性150例,女性27例,年龄25～76岁,平均(55±12)岁.按照是否联合脾切除术,将患者分为切脾组(n=71)和不切脾组(n=106).比较两组在手术安全性、术后并发症发生率、术后肝功能恢复、术后白细胞计数和血小板计数方面的差异.结果 两组患者术前一般情况及白细胞计数和血小板计数的差异无统计学意义(P＞0.05).切脾组术后第1、10、30天血小板计数分别为(88.4±23.6)×109/L、(345.3±98.2)×109/L、(210.8±92.2)×109/L,与不切脾组相比差异有统计学意义(P＜0.05).切脾组手术时间为(216±105)min,高于不切脾组的(135±60)min,差异有统计学意义(P＜0.05),但两组术中出血量及输血的差异无统计学意义.切脾组术后并发症发生率为11.3%,与不切脾组的6.6%相比差异无统计学意义.结论 只要严格掌握适应证,提高围手术期处理水平,肝癌合并肝硬化脾功能亢进患者行肝脾联合切除术是安全的.%Objective To investigate the influence of combined hepatectomy with splenectomy on safty of operation for hepatocellular carcinoma patients complied with cirrhosis and hypersplenism and the best peri-operative treatment of these patients. Methods Clinical data of 177 hepatocellular carcinoma patients complied with cirrhosis and hypersplenism admitted from January 1999 to December 2009 were analyzed retrospectivly. Gmong which, 71 patients received concomitant splenectomy with hepatectomy (splenectomy group), 106 patients only receive a hepatectomy (non-splenectomy group). The safty of operation ,complications,liver function and WBC and PLT counts were compared between the two groups.Resunts There was no significant difference of general conditions, counts of WBC and PLT between the two groups before operation. The counts of PLT at 1,10,30 day after operation were (88.4 ± 23.6) × 109/L,(345.3 ± 98.2) × 109/L and (210. 8 ± 92. 2) × 109/L respectively in splenectomy group, which were signifcantly higher than that of non-splenectomy group(P ＜ 0. 05＝. The operation time of splenectomy group was (216 ± 105) min, which was longer than that of non splenectomy group (P ＜ 0. 05＝, but the blood loss and transfusion rate had not significantly difference between the two groups. The complication rates of splenectomy group and non-splenectomy group were 11.3% and 6. 6% respectively,there was no significant difference between the two groups. Conclusion Combined hepatectomy with splenectomy will be safe for hepatocellular carcinoma patients complied with cirrhosis and hypersplenism as if the operative indication and increase the ability of peri-operative treatment are strictly obeyed.