细针穿刺定位在射频消融治疗脾功能亢进症的应用

The application of position fixing with a fine needle in the treatment of radiofrequency ablation for hypersplenism

目的:探讨细针穿刺定位技术在CT引导下冷循环射频消融(RFA)治疗肝硬化门脉高压性脾功能亢进症(脾亢)的作用和经验。方法:22例脾亢患者在CT引导下行射频消融术,术中先用定位细针穿刺脾脏,然后参照细针位置,再以射频电极穿刺脾脏,确认射频电极位置正确后进行射频消融治疗。术后复查血常规和增强CT或MR以了解血小板(PLT)的变化和脾脏的消融体积。结果:射频电极穿刺总成功率为100%,其中第1次穿刺成功18例,第2次穿刺成功4例,脾脏消融体积为(40.0±5.6)%,术后1个月PLT(105±11)×109/L,与术前PLT(45.0±9.8)×109/L相比显著增高(P<0.05)。没有因为穿刺失误导致的严重并发症发生。结论:应用细针穿刺定位技术,可以提高脾脏射频消融中穿刺的安全性,减少穿刺相关并发症的发生,值得进一步研究和总结。

Objective： To investigate the effect and experience of the technology of position fixing with a fine needle in the treatment of CT-guided radiofrequency ablation（RFA） with cool-tip electrode for hypersplenism in patients with liver cirrhosis and portal hypertension.Methods： 22 patients with the disease were treated by CT-guided RFA with cool-tip electrode.We used a fine needle to puncture the spleen first,and then we used the cool-tip electrode to puncture the spleen guided by the fine needle.Finally we confirmed the position of the electrode was satisfied by CT scan and started to ablate the spleen by the radiofrequency.Blood routine test and enhanced CT or MRI were carried out after treatmeat to observe the change of platelet（PLT） and the spleen ablation volume.Results： All radiofrequency electrodes were puncture successfully.The total puncturatio achievement ratio was 100%.And 18 cases were puncture successfully at the first time,4 cases were puncture successfully at the second time.The percentage of ablation part of spleen from RFA was（40.0±5.6）%.One month after RFA,PLT was（105±11）×109/L.This level was significantly higher than the level before RFA（45.0±9.8）×109/L,（P〈0.05）.No any fateful complication related to puncture mistake occurred.Conclusion： To make use of the technology of fixing position by a fine needle,we can improve the security of puncture by the cool-tip electrode in the treatment of hypersplenism,and reduce the complication related to puncture by the cool-tip electrode.This technology is worthy to a further study and summarize.