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1、肝脾联合切除术治疗肝癌合并肝硬化脾功能亢进的远期疗效6?中华医学杂志2004年1月2曰第84卷第lanedj里坠：肝癌及肝硬化研究.肝脾联合切除术治疗肝癌合并肝硬化脾功能亢进的远期疗效蔡建强胡敬群毕新宇赵建军车旭解世亮邵永孚赵平【摘要】目的探讨肝脾联合切除术治疗肝癌合并肝硬化脾功能亢进的远期疗效.方法对102例肝癌合并肝硬化脾功能亢进患者的临床资料进行回顾性分析.57例行肝脾联合切除术(A组),45例行单纯肝切除术(B组).结果A,B两组术中出血及术后并发症的发生率差异均无显着意义(P>0.05),但术后血小板,白细胞的回升及与肝硬化预后相关的指标谷氨酰转肽
2、酶(GGT)数值的改善,A组明显好于B组(P<0.05).两组1,3,5年复发率分别为27.1%,48.6%,69.3%及41.2%,50.0%,77.9%;生存率分别为92.6%,59」%,41.8%及80.3%,43.9%,29.1%，两组虽然没有统计学差异，但A组的生存情况均好于B组，而且A组复发患者的平均带瘤生存期(12.9个月)亦明显长于B组(6.3个月,P<0.01).结论肝脾联合切除术治疗肝癌合并肝硬化脾功能亢进不但具有良好的安全性且长期随访的结果是满意的.【关键词】癌，肝细胞;肝硬化;脾功能亢进;肝脾联合切除;预后Long-termef
3、fectofunitedhepateetomyandsplenectomyontreatmentothepatocellularcarcinoinacomplicatediSthcirrhosisandhypersplenismCAIJian―iang,HUJing・qun,BIXin—yu,ZHAOJian-jun,CHEXu,XIEShi-liang,SHAOrong-fu,ZHAOP,咎DepartmentofSurgicalOncology,CancerHospital,ChineseAcademyot'MedicalSciences,BeOing1000
4、21,China【Abstract]ObjectiveTodiscussthelong—termeffectofunitedliverandspleenresectionontreatmentof'hepatocellularcarcinoma(HCC)complicatedwithciiThosisandhypersplenism.MethodsrIlleclinicaldataof102patientsofHCCcomplicatedwitllciiThosisandhypersplenism.57ieceivingunitedhepatectomyandsp
5、lenectomy(groupA),and45receivinghepatectomyonly(groupB),wereretrospectivelyexamined.ResultsnevolumeofoperativebloodlossofgroupAwas765ml(100^2400ml),notsignificantlydifferentfromthatofgroupB(720ml,200^2000ml).operativemorbiditywas1.7%(l/57)ofgroupA,significantlyhigherlowerthanthatofgro
6、upB(4.4%,2/45).Aftertheoperation,山eplateletcountincreasedto275.8x!0/LingroupA,significantlyhigherthanthatingroupB(83x10/L.P<0.05);andthewhitebloodceilcountofgroupAincreasedto10.4x10/L,significantlyhigherthanthatofgroupB(4.19x10/L,P<0・05)・Post—perativegammaglutamyltransferase.apr
7、ognosticfactorforlivercirrhosis,ofgroupAwas68U/L,significantlylowerthanthatofgroupB(132U/L,P<O.O5).rI1leincidenceofcomplicationwas29.8%(17/57)ingi・oupA」】otsignificai】tlydiffei・entfromthatofgroupB(33・3%」5/45).rlIlel,3,and5-yeaiTecurrencerateswere27.1%,48.6%,and69.3%ingroupA,versus41
8、・2%，5
