Comparative Analysis Of Hepatectomy And Hepatectomy Combined With Splenectomy In The Treatment Of Liver Cancer With Hypersplenism

Objective:To explore the safety,early postoperative effect and prognosis of hepatectomy combined with spleen removal for the treatment of liver cancer with hypersplenism,and to provide assistance for the treatment of liver cancer with hypersplenism in the clinic.Methods:A total of 86 patients with hepatic carcinoma with hypersplenism who underwent surgery in Shandong Provincial Hospital from January 2008 to December 2013 were retrospectively studied.The patients were divided into the liver cancer resection combined with the spleen resection group according to the surgical procedure.n=45)and the spleen was not removed when the liver cancer was removed(abbreviated as hepatectomy group,n=41).The intraoperative and postoperative blood loss and blood transfusion volume,postoperative complications,early changes of white blood cells,platelets and total bilirubin,and 5-year survival rate and tumor-free survival rate were compared between the two groups.The measurement data were analyzed by independent sample t test,the count data were analyzed by chi-square(?2)test,and the survival analysis was performed by Kaplan-Meier method.P<0.05 was considered statistically significant,that is,there was significant difference.The collected data were compiled using office 2016 and statistical analysis was performed using SPSS 25.0.Results:1.Intraoperative and postoperative blood loss:the mean blood loss(778.41±731.95)mL in the combined group,the intraoperative red blood cell(RBC)volume(4.90±4.70)U,and the mean blood loss in the hepatectomy group(539.27±)776.66)mL,intraoperative red blood cell(RBC)volume(3.01 ± 4.73)U,there was no significant difference in blood loss and red blood cell volume between the two groups(P>0.05).There were 13 cases(28.9%)of red blood cells in the combined group and 4 cases(9.6%)in the liver-cut group.The difference was statistically significant(P<0.05).The average group of red blood cells was 4.45U,and the liver-cut group was The difference was statistically significant(P<0.05).2.postoperative complications:the combined group had an early complication rate of 20%,4 cases of reactive pleural effusion,0 cases of upper gastrointestinal bleeding,1 case of biliary fistula,1 case of pulmonary infection,abnormal bilirubin 1 case was elevated,1 case was infected by incision,13 cases were transfused after operation;the incidence of early complication was 19.5%in hepatectomy group,3 cases were reactive pleural effusion,1 case was upper gastrointestinal hemorrhage,and 1 case was biliary fistula.There were 0 cases of pulmonary infection,3 cases of abnormal bilirubin,1 case of wound infection,and 4 cases of postoperative blood transfusion.There was no significant difference in the incidence of early postoperative complications between the two groups(P>0.05).3.Changes of white blood cells,platelets and total bilirubin in the early postoperative period:the white blood cell count of the combined group was(13.17±5.71)×10~9/L 7 days after operation,which was higher than that of the liver-cut group(9.15±3.15)×10~9/L.Statistical significance(P<0.05).The platelet count at 7 days after operation was(211.96±101.05)×10~9/L,which was higher than that of the liver-cut group(102.02±44.92)×10~9/L,the difference was statistically significant(P<0.05).The total bilirubin level in the combined group was(38.34±23.45)?mol/L,which was lower than that in the hepatectomy group(46.98±34.76)?mol/L.The difference was statistically significant(P<0.05).4.Survival rate after operation:the 5-year cumulative survival rate was 55.6%(25/45)in the combined group and 48.8%(20/41)in the hepatectomy group.There was no significant difference in the 5-year cumulative survival rate between the two groups.(P>0.05).The 1-,3-,and 5-year disease-free survival rates of the combined group were 84.4%(38/45),44.4%(20/45),and 37.8%(17/45),respectively.The liver-cut group had 1,3,and 5 years of tumor-free survival.The rates were 82.9%(34/41),41.5%(17/41),and 19.5%(8/41),respectively.There was no significant difference in the 1-year-old disease-free survival rate between the two groups(P>0.05),and the 5-year disease-free survival rate was significantly different(P<0.05).Conclusion:Combined resection of the spleen is beneficial to the recovery of postoperative liver function.The recovery of total bilirubin after surgery is significantly better than that of the unspleen group.The removal of spleen makes the postoperative WBC and PLT levels return to normal,which is helpful for postoperative chemotherapy.Interventional and other treatments,while removing the spleen can improve the patient's immune function,these two points may improve the patient's 5-year survival rate;combined removal of the spleen will increase postoperative blood transfusion and increase perioperative risk.