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目的:探讨肝癌切除联合脾脏微波消融治疗肝癌合并脾肿大脾功能亢进的临床安全性及中期疗效。方法:回顾分析我院13例肝炎肝硬化后脾功能亢进合并肝癌行肝癌切除联合脾脏微波消融患者的临床资料。结果:脾脏毁损体积占脾脏总体积比例的(34.20±1.72)%。谷丙转氨酶和谷草转氨酶术后第1天明显升高,P值分别为0.039和0.001;术后1周内逐渐恢复至正常或术前水平,P值分别为0.222和0.303。总胆红素术后第1天较术前轻度升高,白蛋白和胆碱酯酶较术前轻度降低,但3者与术前比较差异均无统计学意义,P值分别为0.069、0.073和0.066;术后1周内逐渐恢复正常或术前水平。白细胞术后第1天升高明显,之后轻度下降,术后1、2周和1、3、6个月较术前均升高,P值分别为0.001、0.001、0.028、0.037和0.034。血小板术后第1天、术后1周较术前升高不明显,P值分别为0.908和0.274;术后2周升高显著,P=0.005;术后1、3和6个月较术前均明显升高,差异有统计学意义,P值分别为0.012、0.016和0.020。所有患者均完成治疗,顺利出院,未发生肝功能衰竭、肝肾综合征、肝性脑病、肝断面大量渗血、上消化道出血、脾脓肿、脾脏破裂、顽固性腹水、顽固性疼痛以及门静脉血栓等严重并发症;术后随访6个月未见死亡及肿瘤复发病例,未见上消化道出血及肝功能衰竭病例。结论:肝癌切除联合脾脏微波消融治疗肝癌合并脾肿大脾功能亢进手术安全,中期疗效显著。
Objective: To investigate the clinical efficacy and mid-term efficacy of liver cancer resection combined with splenic microwave ablation in the treatment of hepatocellular carcinoma with splenomegaly and hypersplenism. Methods: The clinical data of 13 patients with hypersplenism after hepatic cirrhosis combined with liver cancer who underwent resection of liver cancer combined with microwave ablation of the spleen were retrospectively analyzed. Results: The volume of spleen damage accounted for (34.20 ± 1.72)% of the total spleen volume. Alanine aminotransferase and aspartate aminotransferase increased significantly on the first postoperative day, with P values of 0.039 and 0.001, respectively. Within 1 week after operation, they returned to normal or preoperative levels with P values of 0.222 and 0.303, respectively. Total bilirubin slightly increased on the first day after operation compared with that before operation, albumin and cholinesterase slightly decreased compared with that before operation, but there was no significant difference between the three groups and before operation (P = 0.069 , 0.073 and 0.066, respectively. Within 1 week after operation, the patients returned to normal or preoperative level gradually. The leukocyte increased significantly on the first postoperative day and then decreased slightly. The postoperative week 1, week 2, postoperative 1, 3, and 6 were higher than preoperatively. The P values were 0.001, 0.001, 0.028, 0.037 and 0.034, respectively. Platelet 1 day after surgery, 1 week after surgery was not significantly increased compared with preoperative, P values were 0.908 and 0.274; 2 weeks after surgery increased significantly, P = 0.005; 1, 3 and 6 months after surgery Before and after the treatment, the levels were significantly increased, the difference was statistically significant, P values were 0.012,0.016 and 0.020. All patients completed the treatment and were discharged without liver failure, hepatorenal syndrome, hepatic encephalopathy, extensive oozing of the liver section, upper gastrointestinal bleeding, splenic abscess, splenic rupture, refractory ascites, refractory pain, and portal vein Thrombosis and other serious complications; no follow-up of 6 months after the death and tumor recurrence cases, no cases of upper gastrointestinal bleeding and liver failure. Conclusion: Liver cancer resection combined with splenic microwave ablation in the treatment of hepatocellular carcinoma with splenomegaly and hypersplenism is safe and has a medium-term curative effect.