CAJ | 학술논문

目的探讨同步腹腔镜肝切除联合脾切除术治疗原发性肝癌并发肝硬化门静脉高压性脾功能亢进的安全性和临床疗效.方法回顾性分析2015年1-4月扬州大学临床医学院收治的5例原发性肝癌并发肝硬化门静脉高压性脾功能亢进患者的临床资料.5例患者施行同步腹腔镜肝切除联合脾切除术,术中行脾血自体回输.观察患者手术时间、术中出血量、术中输血量、术后进食时间、术后拔除引流管时间、术后住院时间及术后并发症发生情况.采用门诊和电话方式随访,随访时间截至2015年6月.正态分布的计量资料以(x)±s表示.结果 5例患者中,3例施行腹腔镜肝切除联合脾切除术,1例施行腹腔镜肝切除+脾切除+胆囊切除术,1例施行腹腔镜肝切除+脾切除+断流术,无1例中转开腹.患者手术时间为(225 ±41) min,术中出血量为(221±81)mL.5例患者均采用了自体血回输技术,无1例患者术中行同种异体输血.2例患者术后发生腹腔积液,其中1例患者同时发生胸腔积液,均经保守治疗后症状消失.所有患者术后第1天进食全流质饮食,术后第2天下床活动,术后第3天拔除引流管.患者术后住院时间为(7.8±0.8)d,均顺利康复出院,无围术期死亡发生.5例患者均获得随访,截至随访时间均生存.结论同步腹腔镜肝切除联合脾切除术治疗原发性肝癌并发肝硬化门静脉高压性脾功能亢进安全可行,且疗效确切.
목적 탐토동보복강경간절제연합비절제술치료원발성간암병발간경화문정맥고압성비공능항진적안전성화림상료효.방법 회고성분석2015년1-4월양주대학림상의학원수치적5례원발성간암병발간경화문정맥고압성비공능항진환자적림상자료.5례환자시행동보복강경간절제연합비절제술,술중행비혈자체회수.관찰환자수술시간、술중출혈량、술중수혈량、술후진식시간、술후발제인류관시간、술후주원시간급술후병발증발생정황.채용문진화전화방식수방,수방시간절지2015년6월.정태분포적계량자료이(x)±s표시.결과 5례환자중,3례시행복강경간절제연합비절제술,1례시행복강경간절제+비절제+담낭절제술,1례시행복강경간절제+비절제+단류술,무1례중전개복.환자수술시간위(225 ±41) min,술중출혈량위(221±81)mL.5례환자균채용료자체혈회수기술,무1례환자술중행동충이체수혈.2례환자술후발생복강적액,기중1례환자동시발생흉강적액,균경보수치료후증상소실.소유환자술후제1천진식전류질음식,술후제2천하상활동,술후제3천발제인류관.환자술후주원시간위(7.8±0.8)d,균순리강복출원,무위술기사망발생.5례환자균획득수방,절지수방시간균생존.결론 동보복강경간절제연합비절제술치료원발성간암병발간경화문정맥고압성비공능항진안전가행,차료효학절.
Objective To investigate the safety and clinical efficacies of synchronous laparoscopic hepatectomy combined with splenectomy for the treatment of hepatocellular carcinoma (HCC) associated with cirrhotic portal hypertensive hypersplenism.Methods The clinical data of 5 patients with HCC associated with cirrhotic portal hypertensive hypersplenism who were admitted to the Clinical Medical College of Yangzhou University between January 2015 and April 2015 were retrospectively analyzed.Five patients underwent synchronous laparoscopic hepatectomy combined with splenectomy and intraoperative autologous blood transfusion.The operation time,volume of intraoperative blood loss,time for diet intake,postoperative drainage tube removal time,duration of hospital stay and occurrence of complications were observed.Patients were followed up by outpatient examination and telephone interview till June 2015.Measurement data with normal distribution were presented as x ± s.Results Of the 5 patients without conversion to open surgery,3 patients underwent synchronous laparoscopic hepatectomy combined with splenectomy,1 patient underwent laparoscopic hepatectomy + splenectomy + cholecystectomy and 1 patient underwent laparoscopic hepatectomy + splenectomy + devascularization.The operation time and volume of blood loss were (225 ± 41)minutes and (221 ± 81)mL.All the patients received intraoperative autologous blood transfusion without homologous blood transfusion.Two patients were complicated with abdominal effusion including 1 patient associated with pleural effusion,and symptoms of 2 patients disappeared after conservative treatment.All the patients took fluid diet at postoperative day 1 and out-of-bed activity at postoperative day 2,and drainage tubes were removed at postoperative day 3,with good recovery and without perioperative death.The duration of postoperative hospital stay was (7.8 ±0.8)days.All the 5 patients were followed up and survived well up to the end of follow-up.Conclusion Synchronous laparoscopic hepatectomy combined with splenectomy is safe and feasible for the treatment of HCC associated with cirrhotic portal hypertensive hypersplenism with an exact curative effect.