不同手术方法治疗伴有脾功能亢进症的原发性肝癌患者临床疗效研究

doi:10.3969/j.issn.1672-5069.2017.05.016

摘要/Abstract

摘要： 目的探讨脾脏处理对行肝癌切除术的原发性肝癌（PLC）患者临床疗效的影响。方法 2006年1月～2016年1月在我院接受治疗的140例PLC患者， A组46例行肝癌切除术联合脾切除术，B组34例行肝癌切除术/脾切除术/贲门周围血管离断术，C组30例行肝癌切除术联合脾动脉结扎术， D组30例行肝癌切除术。结果治疗后C、D组患者血小板计数（PLT）为【（215.4±118.9）×10⁹/L和（176.4±105.5）×10⁹/L】，白细胞（WBC）计数为【（3.36±1.23）×10⁹/L和（2.36±1.21）×10⁹/L】，均显著低于A、B组（P均<0.05）；术后D组患者总胆红素（TBIL）水平为（37.7±5.1） μmol/L，明显高于A组或B组或C组（P均<0.05）；治疗后D组患者CD4+细胞为（28.3±5.9）%，CD4+/CD8+比值为（1.3±0.3）%，均明显低于A、B、C组（P均<0.05）；D组患者术后并发症发生率为33.3%，明显高于A组的17.4%、B组的23.5%和C组的20.0%（P<0.05）。结论行脾处理可以有效改善行肝癌切除术治疗的PLC患者术后肝功能和免疫功能，减少并发症。

关键词: 原发性肝癌, 脾功能亢进症, 肝癌切除术, 脾切除术, 贲门周围血管离断术, 脾动脉结扎术

Abstract: Objective The study was aimed to analyze the clinical implications of splenic management in patients with primary liver cancer underwent hepatectomy. Methods Clinical data of 140 patients with primary liver cancer with underlying liver cirrhosis and hypersplenia between January，2006 and January，2016 was retrospectively analyzed. 46 patients in group A received hepatectomy and splenectomy，34 in group B received hepatectomy and splenectomy and pericardia vascular disconnection，30 in group C received hepatectomy and ligation of splenic artery，and 30 in group D received hepatectomy alone. Results The general materials，operation time，intraoperative blood loss，intraoperative blood transfusion volume in four groups had no statistical difference （P>0.05）；two weeks after treatment，blood PLT and WBC counts in group C were[（215.4±118.9）×10⁹/L and （3.36±1.23）×10⁹/L，in group D were [（176.4±105.5）×10⁹/L and（2.36±1.21）×10⁹/L，much lower than those in group A [（366.8±118.7）×10⁹/L and（7.52±1.18）×10⁹/L]，or in group B [（372.6±119.8）×10⁹/L and （7.54±1.19）×10⁹/L，P<0.05]；serum TBIL，AST and ALT levels in group D were [（37.7±5.1） μmol/L，（65.8±8.2）U/L and （75.8±10.1） U/L，much higher than those in group A[（24.8±4.8） μmol/L，（44.7±10.9）U/L and （50.1±12.2）U/L]，or in group B [（25.5±5.0）μmol/L，（45.8±9.9）U/L and （51.3±12.8） U/L]，or in group C[（24.4±5.0）μmol/L，（45.3±9.5）U/L and（50.4±11.8） U/L，P<0.05]；the percentage of CD4+ cells and CD4+/CD8+ ratio in group D were [（28.3±5.9）% and （1.3±0.3）]，obviously lower than those in group A [（44.1±5.9）% and （2.0±0.2）]，or in group B [（43.5±6.8）% and （2.0±0.3）]，or in group C [（39.2±6.8）% and（1.9±0.2）]，and the percentage of CD8+ cells in group D was （30.3±7.8）%，obviously higher than those in group A（22.0±6.9）%，or in group B（22.4±6.5）%，or in group C（21.8±7.0）% （P<0.05）；the complication occurrence in group D was 33.3%，obviously higher than those in group A，B，C （17.4%，23.5%，20.0%，respectively）. Conclusion The proper management of spleen could significantly improve the immune function and liver function，and the life quality in patients with primary liver cancer.

Key words: Primary liver cancer, Hypersplenia, Hepatectomy, Splenectomy, Gastroesophgeal devasculation, Splenic artery ligation

贺爱军，任羽. 不同手术方法治疗伴有脾功能亢进症的原发性肝癌患者临床疗效研究[J]. 实用肝脏病杂志, 2017, 20(5): 571-574.

He Aijun，Ren Yu.. Splenic management in patients with primary liver cancer underwent hepatectomy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(5): 571-574.

参考文献

[1] Levi SGB，de Werra E，Mascianà G，et al. Laparoscopic and robotic approach for hepatocellular carcinoma-state of the art. Hepatobiliary Surg Nutr，2016，5（6）:478-484.
[2] Mastron JK，Siveen KS，Sethi G，et al. Silymarin and hepatocellular carcinoma:a systematic，comprehensive，and critical review. Anticancer Drugs，2015，26（5）:475-486.
[3] Yap AQ，Chen CL，Yong CC，et al. Clinicopathological factors impact the survival outcome following the resection of combined hepatocellular carcinoma and cholangiocarcinoma. Surg Oncol，2013，22（1）:55-60.
[4] 宋书红，郭俊，邹灿. 肝癌手术切除术后复发相关因素分析. 实用肝脏病杂志，2017，20（2）:203-206.
[5] 沈建东，付守忠. 肝脾双介入治疗原发性肝癌伴脾功能亢进临床应用观察. 基层医学论坛，2015，32（22）:3072-3074.
[6] 张秀军，陈克礼，刘远. 原发性肝癌合并脾功能亢进介入治疗20例分析. 武警后勤学院学报（医学版），2012，21（9）:713-714.
[7] 沈艺南，杨田，张汉，等. 原发性肝癌合并脾功能亢进外科治疗的Meta分析. 腹部外科，2014，27（4）:304-309.
[8] Glantzounis GK，Tokidis E，Basourakos SP，et al. The role of portal vein embolization in the surgical management of primary hepatobiliary cancers. A systematic review. Eur J Surg Oncol，2017，43（1）:32-41.
[9] Levi SGB，Colasanti M，Santoro R，et al. Laparoscopic right hepatectomy for hepatocellular carcinoma in cirrhotic patient. Hepatobiliary Surg Nutr，2015，4（6）:436-438.
[10] Wu C，Bai DS，Jiang GQ，et al. Synchronous double cancers of primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma:a case report and review of the literature. World J Surg Oncol，2014，12:337.
[11] Chun YS，Zimmitti G. Fibrolamellar variant of hepatocellular carcinoma. Recent Results Cancer Res，2013，190:101-110.
[12] Li A，Ma S，Pawlik T，et al. Surgical treatment of double primary liver cancer:An observational study for a rare type of tumor. Medicine （Baltimore），2016，95（32）:e4412.
[13] Yin X，Zhang BH，Qiu SJ，et al. Combined hepatocellular carcinoma and cholangiocarcinoma:clinical features，treatment modalities，and prognosis. Ann Surg Oncol，2012，19（9）:2869-2876.
[14] Leo F，Rapisarda F，Stefano PL，et al. Cavo-atrial thrombectomy combined with left hemi-hepatectomy for vascular invasion from hepatocellular carcinoma on diseased liver under hypothermic cardio-circulatory arrest. Interact Cardiovasc Thorac Surg，2010，10（3）:473-475.
[15] Spolverato G，Ejaz A，Kim Y，et al. Patterns of care among patients undergoing hepatic resection:a query of the National Surgical Quality Improvement Program-targeted hepatectomy database. J Surg Res，2015，196（2）:221-228.
[16] Huang L，Li J，Yan JJ，et al. Prealbumin is predictive for postoperative liver insufficiency in patients undergoing liver resection. World J Gastroenterol，2012，18（47）:7021-7025.
[17] Lee JW，Kim MW，Choi NK，et al. Double primary hepatic cancer （sarcomatoid carcinoma and hepatocellular carcinoma）: A case report. Mol Clin Oncol，2014，2（6）:949-952.