摘要
目的探讨肝细胞癌(HCC)伴脾功能亢进患者肝脾联合切除术后免疫功能和肝功能的变化。方法回顾性分析126例HCC伴脾功能亢进患者的临床资料。根据不同手术方式分2组:肝脾联合切除58例(A组),单纯肝癌切除68例(B组)。比较两组术后血清总胆红素、转氨酶及免疫功能状况。结果术后7 d血清总胆红素A,B组分别为(25±6)μmol/L和(38±12)μmol/L,差异有显著性(P<0.05);术后7 d,A组和B组谷丙转氨酶(ALT)和谷草转氨酶(AST)分别为(49.8±35.8)U/L和(71.8±57.4)U/L,(45.6±39.3)U/L和(61.4±41.2)U/L,两组差异均有显著性(P<0.05)。A,B组两个月后CD4和CD4/CD8分别为(41.7±4.2)和(32.6±3.5),(1.9±0.21)和(1.1±0.18),差异均有显著性(P<0.05)。A,B组术后并发症发生率分别为7.24%(10/58)和16.18%(11/68),差异无显著性(P>0.05),A,B组3和5年无瘤生存率分别为50.0%(14/28)和32.26%(10/31),37.50%(3/8)和20.0%(2/10),差异均有显著性(P<0.05)。结论肝脾联合切除治疗HCC伴脾功能亢进可促进机体T细胞亚群恢复平衡,改善机体抗肿瘤免疫功能,并可减轻术后肝脏胆红素代谢的负担,促进肝功能恢复。术后并发症发生率并不增加,3年和5年无瘤生存率明显提高。
Objective To investigate the change of immune function and liver function in cases of hepatocellular carcinoma （HCC） with hypersplenism after concomitant splenectomy and liver resection. Methods The clinical data of 126 cases of HCC with hypersplenism were analyzed retrospectively. They were divided into two groups according to the different treatment： 58 cases underwent concomitant splenectomy and hepatectomy （group A ） , 68 cases underwent hepatectomy only （group B ）. The total serum bilirubin and aminotransferase levels and immune function were compared between the two groups. Results At 7 days after operation, the total serum bilirubin （ TBIL ） concentration was （ 25 ± 6 ） μmol/L and （ 38 ± 12 ） μmol/L respectively in group A and group B （P 〈 0. 05 ） ;The alanine aminotransferase （ALT） and the aspartate aminotransferase （ AST ） were （ 49.8 ± 35.8 ） u/L and （ 71.8 ± 57.4 ） u/L, （ 45.6± 39.3） u/L and （61. 4 ± 41. 2 ） u/L respectively, in group A and group B on the 12th postoperative day （all P〈0.05）. The levels ofCD4 and CD4/CD8 were（41.7±4.2） and （32.6±3.5）,（1.9±0.21） and （ 1. 1 ± 0. 18 ） , respeetively in group A and group B （ all P 〈 0. 05 ）. The postoperative morbidity was 7.24%（10/58） and 16. 18（11/68） , respectively, in group A and group B （P〉0.05）. The 3-and 5-year disease-free survival rates in group A were 50.0 % （ 14/28 ） and 77.50 % （ 3/8 ） respectively, which were significantly higher than those of group B [ 32. 26 % （10/31） and 20. 0 % （2/10）, P〈0.05 ]. Conclusions Concomitant splenectomy and hepatectomy for HCC with hypersplenism may promote the recovery of balance in the subgroup of T-cell, and improve the patient＇s antitumor immune function. It can alleviate the bilirubin metabolism burden, and promote recovery of liver function, The 3 -and 5- year tumor-free survival rates were improved significantly with no increase of postoperative morbidity.
出处
《中国普通外科杂志》
CAS
CSCD
2008年第1期6-9,共4页
China Journal of General Surgery
基金
湖南省科学技术计划项目(2005109)
关键词
癌
肝细胞
脾功能亢进
脾切除术
免疫功能
Carcinoma, Hepatocellular
Hypersplenism
Splenectomy
Immune Function
