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目的:探讨脾动脉结扎联合肝癌切除术对肝癌并门静脉高压症的治疗效果和临床应用的价值。方法:对2008年10月至2013年10月期间我院收治的84例肝癌并门静脉高压症患者的资料进行回顾性分析,其中脾动脉结扎联合肝癌切除手术的患者50例为研究组,患者34例行肝癌切除及脾切断流术为对照组。比较两组治疗效果及患者术前、术后情况。结果:研究组术前白细胞计数、血小板计数、红细胞计数为(3.1±0.9)×109/L、(58.6±12.7)×109/L、(3.4±0.4)×109/L,术后2周白细胞计数、血小板计数、红细胞计数分别为(5.9±1.5)×109/L、(140.3±50.1)×109/L、(3.6±0.7)×109/L;对照组为术前白细胞计数、血小板计数、红细胞计数为(2.8±1.2)×109/L、(45.8±20.5)×109/L、(3.4±0.4)×109/L,术后2周白细胞计数、血小板计数、红细胞计数为(6.2±0.7)×109/L、(172.5±32.7)×109/L、(3.6±0.3)×109/L。研究组与对照组相比,术后2周白细胞计数、红细胞计数相比差异无统计学意义(P>0.05),但术后2周血小板计数研究组低于对照组,差异有统计学意义(P<0.05)。研究组术前与术后的白细胞计数、血小板计数、红细胞计数相比,差异均有统计学意义(P<0.05)。研究组有17例患者出现术后并发症,占16.0%;对照组有20例患者出现术后并发症,占38.2%;两组对比差异有统计学意义(P<0.05)。结论:根据病情合理选择使用脾动脉结扎联合肝癌切除术治疗肝癌并门静脉高压症,可以有效治疗肝癌和脾功能亢进,促进肝功能恢复,对延长原发性肝癌合并肝硬化脾功能亢进患者的生存时间,提高生活质量,具有重要意义。
Objective: To investigate the therapeutic effect and clinical value of splenic artery ligation combined with resection of liver cancer on hepatocellular carcinoma with portal hypertension. Methods: The data of 84 patients with hepatocellular carcinoma and portal hypertension treated in our hospital from October 2008 to October 2013 were retrospectively analyzed. Among them, 50 patients who underwent splenectomy and resection of liver cancer were the study group and 34 Routine liver cancer resection and splenectomy for the control group. The therapeutic effects of the two groups were compared before and after the operation. Results: The preoperative leucocyte count, platelet count and erythrocyte count were (3.1 ± 0.9) × 109 / L, (58.6 ± 12.7) × 109 / L and (3.4 ± 0.4) × 109 / L respectively. The count, platelet count and erythrocyte count were (5.9 ± 1.5) × 109 / L, (140.3 ± 50.1) × 109 / L and (3.6 ± 0.7) × 109 / L respectively. The control group was preoperative leukocyte count, platelet count, The number of erythrocytes was (2.8 ± 1.2) × 109 / L, (45.8 ± 20.5) × 109 / L and (3.4 ± 0.4) × 109 / L respectively. The white blood cell count, platelet count and erythrocyte count were (6.2 ± 0.7 ) × 109 / L, (172.5 ± 32.7) × 109 / L, (3.6 ± 0.3) × 109 / L. Compared with the control group, there was no significant difference in the number of white blood cells and erythrocyte between the study group and the control group at 2 weeks after operation (P> 0.05), but the platelet count at 2 weeks after operation was lower than that in the control group P <0.05). The preoperative and postoperative white blood cell count, platelet count, red blood cell count in the study group were significantly different (P <0.05). Seventeen patients in the study group had postoperative complications, accounting for 16.0%. In the control group, 20 patients had postoperative complications, accounting for 38.2%. The difference between the two groups was statistically significant (P <0.05). Conclusion: According to the reasonable choice of disease, the use of splenic artery ligation combined with resection of liver cancer in the treatment of hepatocellular carcinoma and portal hypertension can effectively treat liver cancer and hypersplenism and promote the recovery of liver function, and prolong the survival of patients with primary liver cancer complicated with cirrhosis and hypersplenism Time and improve the quality of life, is of great significance.