不同栓塞材料在部分性脾栓塞术治疗肝癌伴脾亢中的临床观察

Clicical Observation of Partial Splenic Embolization With Different Embolic Materials for Hypersplenism in Hepatocellular Carcinoma

目的评价栓塞材料PVA颗粒与真丝线段在部分性脾栓塞术（PSE）治疗肝癌伴脾功能亢进（脾亢）中的临床价值。方法38例肝癌伴脾亢行PSE患者，依据PSE术所采用的栓塞材料不同分为两组：A组19例，栓塞材料为真丝线段；B组19例，栓塞材料为300～500μm的PVA颗粒。随访观察两组外周血白细胞、血小板计数变化及术后反应。结果两组术后6个月内白细胞和血小板计数均较术前明显升高，但两组的疗效差异无显著性；PSE术后两组患者均出现不同程度的疼痛和发热，A组发热的发生率高，B组疼痛的程度重、持续时间长；两组发生比较严重并发症共3例。结论手术丝线和PVA颗粒均可作为PSE治疗肝癌伴脾亢的栓塞材料，两者疗效类似，但术后反应差异有显著性。

Objective To evaluate the clinical value of partial splenic enbolization（PSE） using polyvinyl alcohol（PVA） panicles and silk suture segments as embelie materials for hypersplenism in hepatocellular carcinoma. Methods 38 patients with hypersplenism and hepatocellular carcinoma were treated with PSE and followed - up for 6 months. According to the difference of the embelic material in PSE, 38 patients were divided into 2 groups. Group A： 19 patients with silk suture segnents as the embelic material of PSE; Group B： 19 patients with PVA as the embelic material of PSE. The follow- up indices included peripheral blood cells counts（white blood cell （WBC）, platelet（PLT） and the complications associated with PSE. Results In group A and group B, WBC and PLT counts kept significantly higher in number than pre- einbolization in 6 months after PSE（ P 〈0.01）, but there were not perceivable difference （ P 〉 0.05 ） in curative effect between group A and group B. the most frequent postoperative responses were abdominal pain and fever, the occurrence rate of fever was higher in group A than that in group B,The degree and duration of abdominal pain were higher and longer in group B; 3 patients has happened fairly severe complications in beth groups. Conclusions Silk suture segments and PVA may be used as the embolic materials of PSE in patients with hypersplenism in hepatocellular carcinoma, they were proximate in curative effect and differential in postoperative responses.