摘要
目的探讨原发性肝癌合并脾功能亢进肝脾联合切除对疗效的影响。方法回顾分析23例原发性肝癌合并脾功能亢进的患者行肝癌切除联合脾切除(切脾组,n=10)和肝癌切除联合脾动脉结扎(非切脾组,n=13)手术前、后外周血中CD4、CD8、CD16、CD4/CD8、WBC及PLT的变化,并比较2组的生存率。结果术前2组患者的CD4、CD8、CD16、CD4/CD8、WBC及PLT差异无统计学意义;2组术中出血量和术后并发症发生率的差异亦无统计学意义的;术后3个月,切脾组CD4、CD16、CD4/CD8、WBC及PLT指标比术前显著升高(P<0.01),且明显高于非切脾组(P<0.01);非切脾组术后上述各项指标无明显改变。2组生存率比较差异无统计学意义。切脾组中无一例因白细胞改变而影响术后辅助化疗,而非切脾组有7例因白细胞过低而被迫终止了化疗。结论肝癌切除联合脾切除有利于肝癌合并脾功能亢进患者术后免疫功能的恢复及术后化疗。
Objective To investigate the influence of hepatectomy combined with splenectomy on curative effect of primary hepatocellular carcinoma patients associated with hypersplenism. Methods Twenty three cases of primary hepatocellular carcinoma associated with hypersplenism were analyzed retrospectively and divided into hepatectomy combined with splenectomy group （n= 10） and hepatectomy combined with ligation of splenic artery （n= 13）. Peripheral blood samples were collected 1 week before operation and 3 monthes after operation respectively. The levels of CD4, CDS, CD16, CD4/CDS, WBC and PLT in the blood were detected. Survival rate between the two groups was compared. Results There were not significant differences in the expressional levels of CD4, CD8, CD16, CD4/CD8,WBC and PLT before operation, bleeding quantity during the operation and rate of severe compli- cations after operation in the two groups. The expressional levels of CD4, CD16, CD4/CD8, WBC and PLT of hepa tectomy combined with splenectomy group were much higher in 3 months after operation than those in 1 week before operation and in hepatectomy combined with ligation of splenic artery group （P〈0.01） and the latter with no dis- tinct changes of the above indexes. There was no difference of survival rate between the two groups. But in the hep- atectomy combined with ligation of splenic artery group, 7 patients of 13 patients were compelled to terminate chem- otherapy because of their low WBC while not a single patient was forced to do so in the hepatectomy combined with splenectomy group. Conclusion Hepatectomy combined with splenectomy is useful for patients with hepatocellular carcinoma associated with hypersplenism to restore the immunological function and the application of chemotherapy after operation.
出处
《中国普外基础与临床杂志》
CAS
2005年第5期492-495,共4页
Chinese Journal of Bases and Clinics In General Surgery
关键词
原发性肝癌
肝切除术
脾功能亢进
Primary hepatocellular carcinoma Hepatectomy Hypersplenism
