| 摘要: |
| 目的：探讨肝切除联合脾脏微波消融治疗肝细胞癌（HCC）合并脾功能亢进的安全性和有效性。方法：回顾性分析 34 例因 HCC 合并肝硬化后脾肿大、脾功能亢进而进行部分肝切除联合脾脏微波消融治疗患者的资料，通过手术前后的增强 CT 评估脾脏微波消融体积，通过实验室检查评估手术前后血常规及肝功能改变，并在术后 6 个月定期随访。结果：34例脾脏消融体积平均为（35.3±2.4）%，在随访期内无严重不良事件或手术相关死亡的发生。术后 1 天外周血白细胞水平（12.44±4.45）×109/L 与术前（3.83±1.02）×109/L 相比，其差异显著，具有统计学意义（P<0.01）。外周血小板计数术前平均为（41.04±14.88）×109/L，术后逐渐升高，在术后 2 周达到（113.45±58.33）×109/L。外周血小板计数术前与术后 2 周的差异显著，具有统计学意义（P<0.01）。肝功能 ALT 和 AST 在术后 1 天均升高 , 分别为（564.5±529.8）U/L和（429.1±318.3）U/L，与术前相比，ALT 为（32.8±12.2）U/L，AST 为（34.1±10.7）U/L，其差异均具有统计学意义（P<0.01）；但在术后 7 天 ALT 和 AST 分别恢复至（56.7±43.4）U/L 及（38.8±21.4）U/L，与术前相比，其差异均不具有统计学意义（P>0.05）。术后 1 个月复查 CT 证实所有患者的脾脏损毁体积占术前脾脏总体积的（24.9±4.3）%。结论：肝切除联合脾脏微波消融治疗 HCC 合并肝硬化后脾肿大、脾功能亢进，具有较好的安全性和有效性。 |
| 关键词: 肝细胞癌 脾肿大 微波消融 肝切除术 |
| DOI：10.3969/j.issn.1007-6948.2019.06.035 |
|
| 基金项目: |
|
| Effect of Hepatectomy Combined with Microwave Ablation of Spleen in Treatment of Hepatocellular Carcinoma Complicated with Hypersplenia: A Retrospective Analysis of 34 Cases |
| LI Feng,CHENG Guang-she,LIU Xu-chen |
| Department of Pathology, Tongchuan People' s Hospital, Tongchuan (727100), China |
| Abstract: |
| Objective To investigate the safety and efficiency of hepatectomy combined with splenic microwave ablation for treatment of hepatocellular carcinoma (HCC) complicated with hypersplenia. Methods The patients (34 cases) undergoing hepatectomy combined with splenic microwave ablation for HCC complicated with splenomegaly and hypersplenism which was secondary to cirrhosis were retrospectively analyzed in this study. The ablated volumes of spleen were calculated by enhanced CT scan and the whole blood count and liver function were examined pre- and post-operation. All patients were undergoing 6-months follow up to monitor the complications after surgery. Results Thirty-four cases had an average of (35.3±2.4)% for spleen ablated volumes. The WBC level [(12.44±4.45)× 109/L] 1 day after surgery was significantly different from that before surgery [(3.83±1.02)×109/L], with statistical significance (P<0.01). The average peripheral blood plate count was (41.04±14.88)×109/L before surgery, which gradually increased after surgery and reached (113.45±58.33)×109/L 2 weeks after surgery. The difference of peripheral blood platelet count before and two weeks after operation was significant (P < 0.01). The liver function ALT and AST were both increased 1 day after surgery [(564.5±529.8)U/L and (429.1±318.3)U/L], respectively, compared with that before surgery [ALT, (32.8±12.2)U/L; AST, (34.1±10.7)U/L], the differences were statistically significant (P<0.01). However, ALT was restored to (56.7±43.4)U/L and AST was restored to (38.8±21.4)U/L 7 days after surgery, and the differences were not statistically significant (P>0.05). A review of CT in 1 month after surgery confirmed that the volume of spleen ablation in all patients accounted for [(24.9±4.3)%] of the total preoperative spleen volume. Conclusion It is a safe and effective procedure for HCC patients complicated with splenomegaly and hypersplenism which was secondary to cirrhosis undergoing hepatectomy combined with splenic microwave ablation. |
| Key words: Hepatocellular carcinoma splenomegaly microwave ablation hepatectomy |
