部分性脾栓塞在肝癌介入治疗中的应用（附30例报告）

Applicationofpartialsplenicembolizationin30casesofhepatocelularcarcinomaassociatedwithportalhypertensionandhypersplenismHanMingjun

目的：探讨部分性脾栓塞（ＰＳＥ）在肝癌介入治疗中的意义和方法。材料与方法：采用肝动脉化疗栓塞术（ＴＨＡＥ）和ＰＳＥ并用的方法治疗３０例合并肝硬化、门脉高压和脾功能亢进的肝癌患者。将ＰＳＥ的栓塞材料明胶海绵限制在１６０粒以内以防止过量栓塞。结果：２７例脾栓塞面积在５０％以上；２５例脾功能亢进缓解；２６例食管静脉曲张包括６例有消化道出血者，５例于ＰＳＥ后１年之内未再发生出血；未发生脾脓肿等严重并发症。３例脾栓塞面积在５０％以下的患者中２例脾功能亢进未缓解。结论：ＰＳＥ与ＴＨＡＥ并用是治疗肝癌合并肝硬化、门脉高压和脾功能亢进的安全、有效的方法。栓塞剂定量的方法有助于避免脾的过量栓塞，减少并发症。

Purpose:Tostudytheefectandmethodofpartialsplenicembolization(PSE)intheinterventionaltreatmentofhepatocelularcarcinoma.Materialsandmethods:Transcatheterhepaticarterialembolization(THAE)combinedwithPSEwasperformedin30patientswithhepatocelularcarcinomacomplicatedwithlivercirhosis,portalhypertensionandhypersplenism.GelfoamspongewasusedastheembolicmaterialforPSEandlimitedto160piecestopreventoverembolization.Re-sults:Morethan50%ofsplenicparenchymawasinfarctedin27patients.Leukopeniaandthrombo-cytopeniawerecorrectedbyPSEin25of27patientswithhypersplenism.In26patientswithesophagealvaricesincluding5patientswhohadepisodesofgastrointestinalbleeding,norebleedingocurredinfolow-upperiodof6～7months.Hypersplenismwasnotcorectedin2of3patientswithinfarctedsplenicparenchymalessthan50%.Nosplenicabscesandotherseverecomplicationswereobserved.Conclusion:THAEcombinedwithPSEisasafeandefectiveprocedureforpatientswithhepatocelularcarinomaasociatedwithlivercirrhosis,portalhypertensionandhypersplenism.