肝癌切除联合脾切除治疗肝癌合并脾功能亢进的临床研究

吴安琪; 王琳; 杨燕茹

doi:10.16766/j.cnki.issn.1674-4152.001761

肝癌切除联合脾切除治疗肝癌合并脾功能亢进的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.001761

1.
空军军医大学第一附属医院外科手术室，陕西西安 710032
2.
空军军医大学第一附属医院肝胆胰脾外科，陕西西安 710032

基金项目:

陕西省重点研发计划 2018ZDXM-SF-061

详细信息

通讯作者:
杨燕茹，E-mail：yongaomiye@163.com

中图分类号: R735.7 R619
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- 文章访问数: 159
- HTML全文浏览量: 63
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2020-06-18
- 网络出版日期: 2022-02-19

Clinical study of liver cancer resection combined with splenectomy in the treatment of liver cancer complicated with hypersplenism

WU An-qi¹,
WANG Lin²,
YANG Yan-ru^{1
, ,}

1.
Surgical Operation Room, First Affiliated Hospital of Air Force Military Medical University, Xi'an, Shaanxi 710032, China

摘要

摘要: 目的探讨肝癌合并脾功能亢进患者行肝癌联合脾切除手术的临床效果。方法选取空军军医大学第一附属医院2015年2月—2017年2月收治的原发性肝癌合并脾功能亢进的患者118例，根据手术方式分为肝脾联合切除术组(观察组，66例)和单纯肝切除术组(对照组，52例)。比较2组患者术中出血量和输血量、手术前后红细胞(RBC)、白细胞(WBC)、血小板(PLT)及CD4⁺、CD8⁺、CD4⁺/CD8⁺等T细胞亚型，对比2组患者术后并发症，对患者随访3年比较2组患者的生存情况。结果 2组患者术中出血量和输血量差异无统计学意义(均P>0.05)；2组患者在手术前1周RBC、WBC、PLT、CD4⁺、CD8⁺、CD4⁺/CD8⁺等指标比较差异无统计学意义(均P>0.05)，术后2周观察组WBC、PLT指标明显高于对照组(均P < 0.01)，术后2个月观察组CD4⁺、CD4⁺/CD8⁺指标明显高于对照组(均P < 0.01)；观察组患者肺部感染、胸腔积液、胆漏、消化道出血等并发症发生率为15.15%(10/66)，对照组上述并发症发生率为11.54%(6/52)，2组患者术后并发症发生率比较差异无统计学意义(χ²=0.324，P=0.569)；术后随访3年，观察组无瘤生存率为40.91%(27/66)，对照组为21.15%(11/52)，观察组术后3年无瘤生存率明显高于对照组(χ²=5.199，P=0.023)。结论肝癌切除联合脾切除治疗肝癌合并脾功能亢进患者能有效促进WBC和PLT升高、增强机体免疫功能，提高远期治疗效果，且安全性较高，值得在临床上推广和使用。
- 肝癌切除 /
- 脾切除 /
- 肝癌 /
- 脾功能亢进 /
- 临床效果
Abstract: Objective To investigate the clinical effect of liver cancer resection combined with splenectomy in patients with liver cancer complicated with hypersplenism. Methods Total 118 patients with primary liver cancer with spleen hypersplenism were Selected from February 2015 to February 2017 in our hospital, according to the operation method, who were divided into joint resection of liver and spleen group (observation group, 66 cases) and simple hepatic resection group (control group, 52 cases). Intraoperative blood loss and transfusion volume, red blood cell (RBC), white blood cell (WBC), platelet (PLT), CD4⁺, CD8⁺, CD4⁺/CD8⁺ and other T cell subtypes before and after surgery were compared between the two groups. Postoperative complications were compared between the two groups, and survival of the two groups was compared after 3 years of follow-up. Results There was no significant difference in intraoperative blood loss and blood transfusion between the two groups (all P>0.05). There were no statistically significant differences in RBC, WBC, PLT, CD4⁺, CD8⁺, CD4⁺/CD8⁺ and other indicators between the two groups 1 week before surgery (all P>0.05). The WBC and PLT indicators in the observation group were significantly higher than those in the control group 2 weeks after surgery (all P < 0.01), and the CD4⁺ and CD4⁺/CD8⁺ indicators in the observation group were significantly higher than those in the control group 2 months after surgery (all P < 0.01). The incidence of pulmonary infection, pleural effusion, biliary leakage, gastrointestinal bleeding and other complications in the observation group was 15.15%(10/66), while that in the control group was 11.54%(6/52). The incidence of postoperative complications in the two groups was not statistically significant (χ²=0.324, P=0.569). After 3 years of postoperative follow-up, the tumor-free survival rate of the observation group was 40.91%(27/66) and that of the control group was 21.15%(11/52), and the tumor-free survival rate of the observation group was significantly higher than that of the control group (χ²=5.199, P=0.023). Conclusion Combined splenectomy for hepatocellular carcinoma with hypersplenism can effectively promote the rise of WBC and PLT, enhance the immune function of the body, improve the long-term treatment effect, and is relatively safe, which is worthy of clinical promotion and use.
- Liver cancer resection /
- Splenectomy /
- Liver cancer /
- Hypersplenism /
- Clinical effect

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表 1 表 1 2组原发性肝癌合并脾功能亢进患者术中情况比较(x ±s，mL)

组别	例数	术中出血量	术中输血量
观察组	66	493.63±12.83	387.79±18.71
对照组	52	487.72±19.92	385.97±17.69
t值		1.857	0.537
P值		0.067	0.592

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表 2 2组原发性肝癌合并脾功能亢进患者手术前后血常规指标比较(x ±s, ×10⁹/L)

组别	例数	RBC		WBC		PLT
组别	例数	术前1周	术后2周	术前1周	术后2周	术前1周	术后2周
观察组	66	3.88±0.83	3.65±0.95	1.75±0.85	7.85±0.97^a	63.72±3.83	375.83±9.93^a
对照组	52	3.93±0.87	3.72±0.92	1.73±0.87	3.95±0.93^a	64.86±3.82	278.07±8.92^a
t值		0.318	0.403	0.126	22.079	1.607	54.991
P值		0.751	0.688	0.901	< 0.001	0.111	< 0.001
注：与术前1周比较，^aP < 0.05。

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表 3 2组原发性肝癌合并脾功能亢进患者手术前后T细胞亚群比较(x ±s)

组别	例数	CD4⁺(%)		CD8⁺(%)		CD4⁺/CD8⁺
组别	例数	术前1周	术后2个月	术前1周	术后2个月	术前1周	术后2个月
观察组	66	29.31±0.43	43.26±1.27^a	30.52±0.73	29.25±0.85	1.13±0.26	1.89±0.43^a
对照组	52	29.25±0.52	30.23±1.16	30.41±0.82	29.17±0.95	1.12±0.19	1.21±0.51
t值		0.686	57.465	0.771	0.482	0.241	7.855
P值		0.494	< 0.001	0.443	0.631	0.816	< 0.001
注：与术前1周比较，^aP < 0.05。

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参考文献(19)

[1]	祝妍华, 谢小玲. 门静脉高压症患者行腹腔镜下脾切除联合贲门周围血管离断术围手术期的护理[J]. 浙江临床医学, 2015, 17(11): 2044-2045.
[2]	解长佶, 曾志平, 胡超, 等. 肝癌切除联合脾切除、贲门周围血管离断术治疗肝癌合并脾亢的Meta分析[J]. 中国医学创新, 2018, 15(33): 144-148. doi: 10.3969/j.issn.1674-4985.2018.33.040
[3]	石刚, 李敬东, 王小飞, 等. 联合肝脾切除在原发性肝癌合并肝硬化和脾功能亢进患者中的应用[J]. 川北医学院学报, 2015, 30(5): 615-617. doi: 10.3969/j.issn.1005-3697.2015.05.10
[4]	朱义红, 黄钢, 王书长, 等. 脾动脉栓塞术治疗肝硬化合并脾功能亢进治疗疗效的分析[J]. 中国实用医药, 2017, 12(5): 142-143. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201705071.htm
[5]	毛献双. 肝癌患者手术治疗的临床研究进展[J]. 现代医学与健康研究(电子版), 2019, 3(2): 15-16. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJD201902008.htm
[6]	李健. 肝癌切除与肝癌联合脾切除治疗肝癌合并脾亢的疗效对比分析[J]. 济南: 山东大学, 2019. https://cdmd.cnki.com.cn/Article/CDMD-10422-1019067685.htm
[7]	王宏博, 吉佳琳, 刘鹤男, 等. 脾动脉栓塞术治疗肝癌合并脾功能亢进的疗效分析[J]. 现代肿瘤医学, 2018, 26(8): 1225-1228. doi: 10.3969/j.issn.1672-4992.2018.08.019
[8]	陈志明. 门脉断流术联合脾脏切除术与双介入栓塞术治疗肝硬化门脉高压症疗效对比[J]. 浙江创伤外科, 2015, 20(4): 635-638. doi: 10.3969/j.issn.1009-7147.2015.04.004
[9]	王安朋, 李新力, 杜向辉. 肝癌切除联合全脾切除治疗原发性肝癌合并脾功能亢进的疗效分析[J]. 中国实用医药, 2015, 10(22): 110-111. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201522076.htm
[10]	戎吉龙, 陈建生. 肝脾联合切除术治疗肝癌合并脾功能亢进的临床研究[J]. 现代实用医学, 2017, 29(6): 759-761. doi: 10.3969/j.issn.1671-0800.2017.06.032
[11]	冯欢, 周燕, 覃梅, 等. 全腹腔镜治疗肺部感染并肝癌肝硬化食道静脉曲张出血的护理一例[J]. 中华肺部疾病杂志(电子版), 2015, 8(5): 115-116. doi: 10.3877/cma.j.issn.1674-6902.2015.05.036
[12]	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. doi: 10.3969/j.issn.1672-5069.2017.05.016
[13]	周益龙, 邵冰峰, 徐爱兵, 等. 联合脾脏切除治疗原发性肝癌合并门静脉高压症的临床分析[J]. 南通大学学报(医学版), 2016, 36(5): 420-424. https://www.cnki.com.cn/Article/CJFDTOTAL-NTYX201605016.htm
[14]	宋向东, 刘争, 赵华, 等. 肝脾联合切除治疗肝癌伴肝硬化脾功能亢进临床研究[J]. 中国卫生标准管理, 2016, 7(15): 40-41. https://www.cnki.com.cn/Article/CJFDTOTAL-WSBZ201615022.htm
[15]	徐锋, 戴朝六, 薛建, 等. 肝癌切除联合脾切除治疗肝细胞癌合并脾功能亢进的体会[J]. 中国普外基础与临床杂志, 2014, 21(4): 473-475. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL201404023.htm
[16]	孙国明. 肝脾联合切除治疗肝癌伴肝硬化脾功能亢进的安全性和疗效[J]. 中国现代普通外科进展, 2016, 19(2): 145-146. https://www.cnki.com.cn/Article/CJFDTOTAL-PWJZ201602022.htm
[17]	常娟, 刘合代, 邹明, 等. 部分脾动脉栓塞术在伴肝硬化脾功能亢进的血液透析患者中的应用[J]. 中国血液净化, 2015, 14(5): 318. doi: 10.3969/j.issn.1671-4091.2015.05.017
[18]	ZHANG X Y, LI C, WEN T F, et al. Synchronous splenectomy and hepatectomy for patients with hepatocellular carcinoma and hypersplenism: a case-control study[J]. World J Gastroenterol, 2015, 21(8): 2358-2366. doi: 10.3748/wjg.v21.i8.2358
[19]	班晓杰. 肝脾联合切除治疗肝癌伴肝硬化脾功能亢进的安全性和疗效[J]. 中国实用医刊, 2015, 42(10): 53-54. https://www.cnki.com.cn/Article/CJFDTOTAL-PWJZ201602022.htm