摘要
目的 探讨肝癌合并肝硬化、脾功能亢进时肝癌切除联合脾切除的意义。方法 将204例肝癌合并肝硬化、脾功能亢进患者分为肝癌切除+脾切除组(简称切脾组,n=94)和单纯肝癌切除组(简称不切脾组,n=110),比较两组患者手术后白细胞、血小板、血清总胆红素、免疫功能的变化以及并发症发生和术后5年生存情况。结果 (1)两组患者术前CD4、CD8、CD4 /CD8、IL2、IFN -γ、IL -10水平差异无显著性意义。(2)术后2个月,切脾组CD4和CD4 /CD8分别为( 40 8±4 1 )%和(1 .8±0. 2),高于不切脾组的CD4 ( 33. 8±3. 6 )%和CD4 /CD8 ( 1 .1±0 .3 ),而切脾组CD8 ( 25 .8±3 .8)%低于不切脾组CD8(32. 9±4 .1% ),差异均有显著性意义(P<0. 05);切脾组IFN -γ和IL2分别为(102 2±14 8)pg/ml和(98 1±15. 5)pg/ml,高于不切脾组的IFN -γ(85. 6±14 .7)pg/ml和IL2(77. 7±14 .2)pg/ml,而切脾组IL10(56. 8±10. 3)pg/ml低于不切脾组IL 10 (72. 8±15 4)pg/ml,差异均有显著性意义(P<0 .05)。(3)术后14d,切脾组白细胞和血小板计数分别为(9 1±1 4)×109 /L和(310±55)×109 /L,明显高于不切脾组的(3. 6±1. 2)×109 /L和(99±36)×109 /L,两组差异有显著性意义(P<0 .01)。(4)术后第7天,切脾组血清总胆红素为(24±7)μmol/L。
Objective To investigate the role of united hepatectomy and splenectomy in the surgical treatment of hepatocellular carcinoma complicated with hepatic cirrhosis and hypersplenism. Methods Two hundred and four patients of hepatocellular carcinoma complicated with liver cirrhosis and hypersplenism were divided into two groups: the group of combined resection of hepatocellular carcinoma and spleen(group A, n=94) and the group of hepatectomy only(group B, n=110).The counts of white blood cell and platelet, total serum bilirubin levels, changes of immune function, operative morbidity and 5-year survival rates were compared between the two groups. Results (1) There was no significant difference of the counts of CD4,CD8,CD4/CD8 and the levels of IL-2,IFN-γ and IL-10 between the two groups before the operation. (2)Two months after operation, the percentage of CD4 and the ratio of CD4/CD8 were significantly higher in the group A [(40.8±4.1)% and (1.8±0.2)%, respectively] than those of group B[(33.8±3.6)% and (1.1±0.3)%,respectively],while the percentage of CD8 was (25.8±3.8)% in the group A, significantly lower than that of group B[(32.9±4.1)%, P<0.05];Both the levels of IFN-γ and IL-2 were significantly higher in the group A than those of group B while the level of IL-10 in group A was lower compared with that of group B (P<0.05). (3) On the 14 postoperative day, the counts of white blood cell and platelet were (9.1±1.4)×10 9/L and (310±55)×10 9/L,which were significantly higher than those of group B[(3.6±1.2) ×10 9/L and (99±36)×10 9/L,respectively]. (4)On the 7th postoperative day, the total serum bilirubin concentration of group A [(24±7) μmol/L] was lower than that of group B[(37±13) μmol/L]. (5)There was no significant difference in the postoperative morbidities between the two groups (15.9% and 14.5%, respectively). (6)There was no significant difference of the 5-year cumulative survival rates between group A (56.4%) and group B (50.9%, P>0.05), but the survival rate without tumor of group A was 37.7%, higher than that of group B (18.9%,P<0.05). Conclusions The combined resection of hepatocellular carcinoma and spleen for the hepatocellular carcinoma complicated with liver cirrhosis and portal hypertension may promote the recovery of the balance between the subgroup of T cell and B cell, normalize the counts of white blood cell and platelet, alleviate the bilirubin burden and benefit for the recovery of liver physiological role without increase; the 5-year disease-free survival rate was improved significantly while no increase of postoperative morbidity. Combined resection may also be helpful for the delay of the progression of liver cirrhosis and for the prevention of esophageal variceal bleeding.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2005年第7期442-446,共5页
Chinese Journal of Surgery
