探讨腹腔镜肝癌切除术联合脾脏切除对肝癌合并脾功能亢进的早期疗效。

回顾性分析2016年1月至2019年5月接受腹腔镜手术治疗的54例肝癌合并脾功能亢进患者临床资料。将肝癌切除同时行脾脏切除者纳入切脾组(25例)，仅行肝癌切除术保留脾脏者纳入保脾组(29例)。临床数据使用统计学软件SPSS 24.0分析，术中术后各项指标、肝功能及免疫指标采用(±s)表示，独立样本t检验；术后并发症等组间比较采用χ²检验。P<0.05为检验标准。

两组患者均成功完成手术，无中转开腹。切脾组手术时间明显较保脾组更长(P＝0.003)，术中出血量及术后住院时间差异无统计学意义(P>0.05)。术后1周，两组患者外周血WBC、PLT均较术前明显升高，且切脾组显著高于保脾组(P<0.05)；两组患者肝功能指标ALT、AST、Tbil均较术前明显升高，保脾组较切脾组更高(P<0.05)；术后免疫功能指标切脾组CD4、CD4/CD8显著升高，而CD8显著降低，且明显优于保脾组(P<0.05)。切脾组及保脾组患者早期并发症发生率分别为16.0%及17.2%，两组间差异无统计学意义(P>0.05)。

腹腔镜肝癌切除联合脾脏切除治疗肝癌合并脾功能亢进安全可行，降低了手术创伤，早期疗效满意。

To investigate the early effect of laparoscopic hepatectomy combined with splenectomy on hepatocellular carcinoma with hypersplenism.

The clinical data of 54 patients of hepatocellular carcinoma with hypersplenism treated by laparoscopic surgery in our hospital were retrospectively analyzed. The patients who underwent liver cancer resection and splenectomy were included in splenectomy group, while those who underwent liver cancer resection and spleen preservation were included in spleen preserving group. The data were analyzed by SPSS24.0 statistical software, Among them, the number of complications and other counting data were expressed by n(%), and the results were compared with χ². The measurement data such as Perioperative indexes、peripheral blood indexes were expressed in (±s), and compared with Independent sample t test and paired t test, P<0.05 was considered statistically significant.

The operation was successfully completed in both groups without conversion to laparotomy. There were significant differences in operation time between the two groups (P=0.003), and no significant difference in intraoperative blood loss and postoperative hospital stay (P>0.05). The changes of WBC, PLT, liver function and immune function in peripheral blood of the two groups before and one week after operation were compared. There was no significant difference in preoperative indexes (P> 0.05). One week after operation, WBC and PLT in peripheral blood of the two groups were significantly higher than those before operation, and splenectomy group were significantly higher than those of spleen preserving group (P<0.05); ALT, AST and Tbil in the two groups were significantly higher than those before operation, while those in spleen preserving group were more significant than those in splenectomy group (P<0.05); CD4, CD4/CD8 in the immune function were not significantly changed after operation in spleen preserving group (P>0.05); CD4, CD4/CD8 in splenectomy group were not significant changes after operation (P>0.05). It was significantly higher than that of spleen preserving group, while CD8 was significantly lower than that of spleen preserving group (P<0.05). The incidences of early complications in splenectomy group and spleen preserving group were 16.0% and 17.2%, respectively. There was no significant difference between the two groups (P>0.05).

Laparoscopic hepatectomy combined with splenectomy is safe and feasible for the treatment of hepatocellular carcinoma with hypersplenism, which reduces the surgical trauma and is conducive to the recovery of patients after operation, and the early treatment effect is satisfactory.