PSE联合TACE治疗原发性肝癌伴脾功能亢进的临床研究

Study on primary hepatocellular carcinoma associated with Hypersplenism treated by PSE combined with TACE

目的探讨部分脾动脉栓塞(PSE)联合肝动脉化疗栓塞(TACE)治疗原发性肝癌并发脾功能亢进的意义。方法对89例原发性肝癌伴不同程度肝硬化、门静脉高压、脾肿大和白细胞、血小板低下等脾功能亢进征象的患者采用部分脾栓塞术和肝动脉化疗栓塞术双介入治疗,术后观察外周血细胞改变。结果本组病例肝脾双介入治疗后外周白细胞、血小板均有显著增高,与术前比较,在统计学上有显著差异(P<0.05)。部分脾栓塞可以缓解脾功能亢进,减轻门静脉高压,减少并发症,保证肝动脉化疗栓塞的顺利进行;而术后增加脾栓塞的反应一般都能忍受。结论肝脾动脉双介入栓塞是一种损伤小、安全程度高、不良反应少、疗效较好的治疗方法,可部分替代外科切脾手术,是治疗肝癌并脾功能亢进较好的治疗方法,值得普及推广。

Objective To investigate the value of partial splenic embolization（PSE） combined with transcatheter arterial chemoembolizatian（TACE） for the treatment of primary hepatocellular carcinoma with portal hypertension and hyperslenism. Methods Eighty - nine patients of hepatocellular carcinoma with signs of hypersplenia such as cirrhosis, hypertension of portal vein, splenomegaly, leukopenia and thrombocytopenia were treated with partial splenic embolization and tran- scatheter arterial chemoembolization. Changes of peripheral blood routine test were recorded after therapy. Results After therapy, the number of white blood cells and platelet was increased significantly compared with that before treatment （ P 〈 0. 05 ）. PSE could reduce hypersplenia and hypertension of portal vein, relieve complications as a result to ensure the therapy of TACE. Most patients tolerated the response of PSE well. Conclusion Transcatheter chemoembolizations of PSE and TA- CE is a less invasive, safe, and effective method with few adverse effects. It is a kind of promising in the treatment of hepato- cellular carcinoma with hypersplenia and could replace splenectomy partially.