解长佶 曾志平 胡超

【摘要】 目的：系统评价肝癌切除联合脾切除、贲门周围血管离断术治疗肝癌合并脾功能亢进（简称脾亢）的安全性。方法：计算机检索国内外文献数据库，收集肝癌切除联合脾切除、贲门周围血管离断术研究的相关论文，根据纳入、排除标准筛选文献、提取资料并评价质量后，采用RevMan 5.3软件进行Meta分析。结果：终纳入3篇对照研究，共144例患者；肝脾联合切除+贲门周围血管离断术组（HSP）与肝脾联合切除组（HS）围术期死亡率、并发症发生率及术后白细胞计数、血小板、肝功能胆红素水平比较，差异均无统计学意义（P>0.05）。结论：对于肝癌合并脾功能亢进患者，肝脾联合切除+贲门周围血管离断术与肝脾联合切除在围术期死亡率、并发症发生率以及白细胞、血小板、肝功能方面无差异性。

【关键词】 肝癌； 脾功能亢进； 脾切除； 贲门周围血管离断术； Meta分析

【Abstract】 Objective：To evaluate the safety of liver cancer resection combined with splenectomy and pericardiac devascularizasion in treatment of liver cancer complicated with hypersplenism.Method：The computer searches the domestic and foreign literature database，related papers on liver cancer resection combined with hypersplenism and pericardial devascularization were collected.According to inclusion and exclusion criteria，literature was selected，data were extracted and quality was evaluated.RevMan 5.3 software was used for meta-analysis.Result：Finally，3 controlled studies were included，a total of 144 patients.The perioperative mortality，incidence of complications，leukocyte count，platelet count and bilirubin level of liver function in liver cancer resection combined with splenectomy and pericardiac devascularizasion（HSP） group and liver cancer resection combined with splenectomy（HS） group were compared，the differences were not statistically significant（P>0.05）.Conclusion：For patients with liver cancer complicated with hypersplenism，there is no difference between liver cancer resection combined with splenectomy and liver cancer resection combined with splenectomy and pericardiac devascularizasion in perioperative mortality，incidence of complications，leukocyte，platelet and liver function.

【Key words】 Liver cancer； Hypersplenism； Splenectomy； Pericardiac devascularizasion； Meta analysis

First-authors address：Jiangxi Tumor Hospital，Nanchang 330029，China

doi：10.3969/j.issn.1674-4985.2018.33.040

肝癌是我國常见的恶性肿瘤之一，并且我国的肝癌是在乙肝背景下形成不同程度的肝硬化合并门静脉高压症、脾功能亢进症，部分患者食管胃底静脉曲张破裂出血引起上消化道大出血导致死亡。因此在治疗肝癌的同时，处理门静脉高压症、脾功能亢进症具有重要的临床意义。手术是肝癌首选的治疗方案。肝脾联合切除术在肝癌合并门静脉高压症与脾功能亢进症中对比与单独肝癌切除术，其手术安全性及疗效已经得到广泛认可[1-3]。而一些临床研究认为肝脾联合切除的基础上行贲门周围血管离断术具有更好的临床疗效。为……