【摘要】目的 探討原發(fā)性肝癌合并脾功能亢進(jìn)肝脾聯(lián)合切除對(duì)療效的影響。
方法 回顧分析23例原發(fā)性肝癌合并脾功能亢進(jìn)的患者行肝癌切除聯(lián)合脾切除（切脾組，n=10）和肝癌切除聯(lián)合脾動(dòng)脈結(jié)扎（非切脾組，n=13）手術(shù)前、后外周血中CD4、CD8、CD16、CD4/CD8、WBC及PLT的變化，并比較2組的生存率。
結(jié)果 術(shù)前2組患者的CD4、CD8、CD16、CD4/CD8、WBC及PLT差異無統(tǒng)計(jì)學(xué)意義； 2組術(shù)中出血量和術(shù)后并發(fā)癥發(fā)生率的差異亦無統(tǒng)計(jì)學(xué)意義的； 術(shù)后3個(gè)月，切脾組CD4、CD16、CD4/CD8、WBC及PLT指標(biāo)比術(shù)前顯著升高（P＜0.01），且明顯高于非切脾組（P＜0.01）； 非切脾組術(shù)后上述各項(xiàng)指標(biāo)無明顯改變。2組生存率比較差異無統(tǒng)計(jì)學(xué)意義。切脾組中無一例因白細(xì)胞改變而影響術(shù)后輔助化療，而非切脾組有7例因白細(xì)胞過低而被迫終止了化療。
結(jié)論 肝癌切除聯(lián)合脾切除有利于肝癌合并脾功能亢進(jìn)患者術(shù)后免疫功能的恢復(fù)及術(shù)后化療。
引用本文： 吉鴻,黎一鳴,徐心,曹罡,楊文彬. 原發(fā)性肝癌合并脾功能亢進(jìn)患者肝脾聯(lián)合切除對(duì)療效的影響. 中國普外基礎(chǔ)與臨床雜志, 2005, 12(5): 492-495. doi: 復(fù)制
| 1. | Shewchuk LD, Baracos VE, Field CJ. Reduced splenocyte metabolism and immune function in rats implanted with the Morris Hepatoma 7777 [Ｊ]. Metabolism， 1996; 45(7)∶848. |
| 2. | Sugawara Y, Yamamoto J, Shimada K, et al. Splenectomy in patients with hepatocellular carcinoma and hypersplenism [Ｊ]. J Am Coll Surg， 2000; 190(4)∶446. |
| 3. | Waghorn DJ. Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed [Ｊ]. J Clin Pathol， 2001; 54(3)∶214. |
| 4. | 吳厚慧，徐鹿平，劉鳳強(qiáng)，等. 肝硬化巨脾切除對(duì)免疫功能的影響 [Ｊ]. 肝膽胰外科雜志， 2000； 12（2）∶80. |
| 5. | Chuang WL, Liu HW, Chang WY, et al. Natural killer cell activity in patients with liver cirrhosis relative to severity of liver damage [Ｊ]. Dig Dis Sci， 1991; 36(3)∶299. |
| 6. | 馮志杰，任錫玲，鄧永貴，等. 肝炎后肝硬化患者自然殺傷細(xì)胞活性測定及其臨床意義 [Ｊ]. 中華內(nèi)科雜志， 1995； 34（7）∶479. |
| 7. | Ohira M, Umeyama K, Taniura M, et al. An experimental study of a splenic inhibitory factor influencing hepatic regeneration [Ｊ]. Surg Gynecol Obstet， 1987; 164(5)∶438. |
| 8. | Lin MC, Wu CC, Ho WL, et al. Concomitant splenectomy for hypersplenic thrombocytopenia in hepatic resection for hepatocellular carcinoma [Ｊ]. Hepatogastroenterology, 1999; 46(26)∶630. |
- 1. Shewchuk LD, Baracos VE, Field CJ. Reduced splenocyte metabolism and immune function in rats implanted with the Morris Hepatoma 7777 [Ｊ]. Metabolism， 1996; 45(7)∶848.
- 2. Sugawara Y, Yamamoto J, Shimada K, et al. Splenectomy in patients with hepatocellular carcinoma and hypersplenism [Ｊ]. J Am Coll Surg， 2000; 190(4)∶446.
- 3. Waghorn DJ. Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed [Ｊ]. J Clin Pathol， 2001; 54(3)∶214.
- 4. 吳厚慧，徐鹿平，劉鳳強(qiáng)，等. 肝硬化巨脾切除對(duì)免疫功能的影響 [Ｊ]. 肝膽胰外科雜志， 2000； 12（2）∶80.
- 5. Chuang WL, Liu HW, Chang WY, et al. Natural killer cell activity in patients with liver cirrhosis relative to severity of liver damage [Ｊ]. Dig Dis Sci， 1991; 36(3)∶299.
- 6. 馮志杰，任錫玲，鄧永貴，等. 肝炎后肝硬化患者自然殺傷細(xì)胞活性測定及其臨床意義 [Ｊ]. 中華內(nèi)科雜志， 1995； 34（7）∶479.
- 7. Ohira M, Umeyama K, Taniura M, et al. An experimental study of a splenic inhibitory factor influencing hepatic regeneration [Ｊ]. Surg Gynecol Obstet， 1987; 164(5)∶438.
- 8. Lin MC, Wu CC, Ho WL, et al. Concomitant splenectomy for hypersplenic thrombocytopenia in hepatic resection for hepatocellular carcinoma [Ｊ]. Hepatogastroenterology, 1999; 46(26)∶630.