Abstract: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 of CD4 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.