部分脾栓塞术治疗肝癌合并脾功能亢进的疗效

Partial Splenic Embolization for Hypersplenism Concomitant with Liver Cancer

目的 评价部分脾栓塞术治疗肝癌合并肝硬化脾功能亢进 (脾亢 )的价值。方法 将 5 2例肝癌合并脾亢的患者分成部分脾栓塞 (partialsplenicembolization ,PSE)组和部分脾栓塞 (PSE) +肝动脉化疗栓塞 (transcatheterhepaticarterialchemoem bolization ,THAE)组。术前、术后第 2、3、5、7天及 3个月观察血像变化。结果 43例患者血像恢复正常 ,47例栓塞体积大于5 0 .0 %。部分脾栓塞后患者的血像从第 2天开始升高 ,白细胞总数在第 3～ 5天达到峰值 ,从 (2 .5 9± 0 .5 8)× 10 9/L升至 (11.17±5 .45 )× 10 9/L ,中性粒细胞从 (1.48± 0 .5 2 )× 10 9/L升至 (8.74± 4.2 3)× 10 9/L ,5～ 9天血小板达到峰值从 (5 2 .14± 2 0 .86 )× 10 9/L升至 (12 3 .41± 2 6 .47)× 10 9/L。 3个月后稳定值白细胞总数为 (4.6 3± 3 .0 2 )× 10 9/L ,中性粒细胞为 (3 .44± 2 .2 7)× 10 9/L ,血小板为 (86 .18± 2 0 .45 )× 10 9/L。白细胞升高以中性粒细胞为主。结论 部分脾栓塞能替代脾切除改善脾亢 ,肝动脉化疗栓塞结合部分脾栓塞治疗肝癌合并肝硬化脾亢的方法安全有效。

Objective To evaluate the efficacy of partial splenic embolization(PSE) in the treatment of liver cancer with hypersplenism.Methods A total of 52 patients with liver cancer and hypersplenism were treated by PSE.20 cases were treated with PSE only,32 cases with PSE plus transcatheter hepatic arterial chemoembolization(THAE).Blood cell counts were compared before PSE and in 2,3,5,7 days,3 months after PSE.Results Blood cell counts were corrected by PSE in 43 of 52 patients.More than 50.0% volume of splenic parenchyma was infarcted in 47 patients.Blood cell counts began to increase in 2 days after PSE.The white blood cell(WBC) count rose from(2.59±0.58)×109/L to a peak of(11.17±5.45)×109/L.After a mean follow-up of 3 months the WBC count stabilized at(4.63±3.02)×109/L.The platelet count rose from(52.14±20.86)×109/L to a peak of(123.41±26.47)×109/L and stabilized at(86.18±20.45)×109/L.Conclusion This study suggests that PSE might be useful as an alternative to surgical splenectomy in the treatment of hypersplenism.THAE combined with PSE is a safe and effective therapy for patients with liver cancer concomitant hypersplenism.PSE make those patients successfully undergo hepatic arterial chemoembolization.