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目的探讨肝癌切除联合全脾切除治疗原发性肝癌(PHC)合并继发性脾功能亢进(SHS)的疗效。方法 175例PHC合并SHS患者,随机分为观察组(93例)与对照组(82例),观察组治疗方案为肝癌切除术联合全脾切除术,对照组治疗方案为单纯性肝癌切除术。结果 1两组患者术中出血量[(475±155)ml VS(450±135)ml]相比,差异无统计学意义(P>0.05)。2手术前,两组患者红细胞(RBC)[(3.1±0.4)×1012/L VS(3.0±0.5)×1012/L]、白细胞(WBC)[(1.83±0.55)×109/L VS(1.75±0.52)×109/L]、血小板(PLT)[(64±13)×109/L VS(66±15)×109/L]相比,差异无统计学意义(P>0.05);术后60 d,两组患者RBC[(3.4±0.3)×1012/L VS(3.3±0.4)×1012/L]相比,差异无统计学意义(P>0.05),观察组WBC[(7.19±1.39)×109/L VS(2.74±0.63)×109/L]、PLT[(375±59)×109/L VS(185±28)×109/L]高于对照组(P<0.05)。3两组患者并发症发生率(18.3%VS 17.1%)、病死率(3.2%VS 4.9%)相比,差异无统计学意义(P>0.05)。结论肝癌切除术联合全脾切除术是治疗PHC合并SHS的理想方案。
Objective To investigate the efficacy of hepatectomy combined with splenectomy in the treatment of primary hepatocellular carcinoma (PHC) complicated with secondary hypersplenism (SHS). Methods One hundred and seventy-five patients with PHC and SHS were randomly divided into observation group (n = 93) and control group (n = 82). The treatment group was treated by hepatectomy combined with splenectomy. The control group was treated by simple hepatectomy. Results 1 There was no significant difference in the amount of bleeding between the two groups [(475 ± 155) ml VS (450 ± 135) ml] (P> 0.05). 2 Before operation, RBC, WBC, [(3.1 ± 0.4) × 1012 / L vs (3.0 ± 0.5) × 1012 / L vs There was no significant difference between the two groups (P> 0.05). There was no significant difference between the two groups (P> 0.05) There was no significant difference in RBC [(3.4 ± 0.3) × 1012 / L VS (3.3 ± 0.4) × 1012 / L] between the two groups (P> 0.05) ) × 109 / L VS (2.74 ± 0.63) × 109 / L], and PLT [(375 ± 59) × 109 / L VS (185 ± 28) × 109 / L] were higher than those in the control group (P <0.05). There were no significant differences in complication rates (18.3% vs 17.1%) and mortality (3.2% vs 4.9%) between the two groups (P> 0.05). Conclusion Hepatectomy combined with splenectomy is the ideal treatment for PHC and SHS.