三丙烯微球在原发性肝癌合并脾功能亢进双介入治疗中的应用

The Application of Three Propylene Microspheres in Double Interventional Therapy of Hepatocellular Carcinoma Merging Hypersplenism

目的探讨三丙烯微球用于原发性肝癌合并脾功能亢进双介入治疗中的安全性和临床疗效。方法对30例原发性肝癌合并脾功能亢进的患者首先实施超选择插管对肝肿瘤供血动脉用碘化油和化疗药物的混合乳剂进行肿瘤微循环血管栓塞,再用直径500μm^700μm的三丙烯微球栓塞肿瘤供血动脉,透视下观察血流明显减慢或血管铸型时停止。再插管至脾动脉下极,用直径500μm^700μm的三丙烯微球进行超选择性脾动脉部分栓塞术,脾栓塞量60%~70%,术后第1、3、7、14、30天分别化验血常规,术后每月做肝脏增强CT或增强MRI检查随访,查AFP及肝功能,观察临床疗效。结果 30例患者,实验室检查:AFP下降,WBC术后24h,30例患者白细胞明显升高,其中有22例患者白细胞数值在正常范围;术后7天,29例WBC基本正常、只有1例略低于正常。PLT术后24h PLT有3例可见升高、27例未见明显改变;术后7天PLT显著升高20例,10例已经基本正常。术后30天CT复查肝肿瘤直径均不同程度的缩小,肿瘤内碘油完全沉积18例,沉积≥80%9例,沉积≤10%3例;脾实质梗死面积达70%11例、60%9例、50%10例。结论三丙烯微球用于原发性肝癌合并脾功能亢进双介入治疗中的临床疗效显著、性能安全可靠,在栓塞肝脏肿瘤组织的同时栓塞部分脾动脉,使门静脉高压降低,升高了白细胞、血小板数量,提高了患者的免疫力,降低了术后不良反应和严重并发症的发生。

Objective To investigate the threepropylene mierospheres safety and chnieal efficacy in double interventional treatment for primary liver cancer with hypersplenism. Method 30 eases of primary liver cancer complicated with hypersplenism patients with first implementation of superseleetive catheterization of hepatic neoplasms with blood supply arteries mixed emulsion of lipiodol and chemotherapy drugs used for vascular embolization of tumor micreeirculation, and three 500 - 700 μm in diameter acrylic Microsphere embolization of tumor blood supply arteries, perspective - under had a much slower blood flow or vascular cast time stop. From intubation to splenic artery the lower, with a diameter of three propylene 500 - 700 μm to superseleetive partial splenic artery embolization with microspheres, splenic embolization 60% percent, postoperative l th, 3, 7, 14 and 30 days respeetivdy for testing blood, postoperative reinforced CT or MRI of the liver cheek every month follow-up. Cheek the AFP and liver function, and observe the clinical effects. Restdt 30 example patients, laboratory inspection： AFP drops, WBC： After 24 H, and 30 cases white blood cells significantly increases. Including 22 patients white blood cell values in the normal range; After 7 days, 29 cases wbc normal, only one case slightly lower than normal. PLT： visible elevated, 24h PLT 3 after cases of 27 patients with no significant change of PLT 7 days after a significant increase in 20 cases, 10 were normal. After 30 days ct review of liver tumor diameter varying degrees of narrowing, completely lipiodol deposition within the tumor in 18 eases, deposition ~〉 80% 9 cases, deposition ~〈 10% 3 cases; Splenic infarct size up to 70% in 11 eases, 60% of the 9 cases, 50% of the 10 cases. Conclusion The three acrylic microspheres for hepatoeellular carcinoma with hypersplenism double interventional therapy clinically significant effect, safe and reliable performance, the emboliza- tion of liver tumors, while partial splenic artery embolization, the reduction of portal hypertension, elevated white blood cell, platelet count, improve the patient＇s immune system, reducing the adverse reactions and serious postoperative complications.