비보상성 간경화를 가진 간세포암 환자에서 간 절제와 비장절제를 동시에 시행한 1예

Abstract

Hepatocellular carcinoma (HCC) develops on chronic liver disease and often accompanies portal hyperternsion. Portal hypertension induces hypersplenism with splenomegaly. Because hypersplenism results in pancytopenia, especially thrombocytopenia, it is not easy to decide the hepatic resection for many surgeons in patients with HCC and hypersplenism. Although liver transplantation is the most ideal treatment for HCC and hypersplenism, liver resection has been performed commonly because of donor shortage. Splenectomy has performed to control intractable varices as a Hassab`s operation (=decongestion of upper gastric marginal veins and splenectomy). Recently, as a development of surgical techniques and equipments, especially laparoscopic surgery, splenectomy has been performed safely and easily. Some studies reported that splenectomy improved the liver function. Splenectomy in patients with HCC expanded the indication of liver resection and increased disease free survival (DFS). However, portal vein thrombosis (PVT) is a one of well-recognized complications of splenectomy and recent prospective study reported the 50% rate of PVT in non-cirrhotic splenectomized patients. Some studies reported that splenectomy with simultaneously or staged liver resection was performed safely without a significant complication and operative mortality. We experienced a case that underwent simultaneously liver resection and splenectomy and then recovered without complication. The further study may be needed to evaluate the role of splenectomy in patients with HCC and hypersplenism