脾动脉栓塞治疗肝癌伴肝硬化脾功能亢进20例体会

Splenic arterial embolization for the treatment of 20 liver cancer patients complicated with liver cirrhosis and hypersplenism

目的 探讨脾动脉栓塞对原发性肝癌伴肝硬化脾功能亢进的治疗效果。方法 采用常规的Seldinger法做脾动脉栓塞共 2 0例 ,术前血小板计数 :1 9× 10 9/L～ 4 9× 10 9/L。肝脾动脉同时栓塞 10例 ,肝癌行无水酒精注射并脾动脉栓塞 2例 ,肝癌切除术又行脾动脉栓塞 7例 ,脾动脉栓塞后再行肝癌切除 1例。行 1次脾动脉栓塞 15例 ,2次脾动脉栓塞 4例 ,3次脾动脉栓塞 1例。结果 脾动脉栓塞后 5d血小板计数上升近 1倍 ,7d后恢复到正常范围。 2 0例患者术后均有脾区疼痛 ,14例有发热 ,随访时间平均为 9 6个月 ,目前均存活。其中 5例血小板低于正常范围 ,但高于术前水平。结论 脾动脉栓塞使患者免于手术切脾 ,可保留脾脏的免疫功能 ,又有效地缓解脾功能亢进。此法相对安全、有效 ,并发症少 。

Objective To investigate the therapeutic method of hypersplenism caused by liver cirrhosis in hepatocellular carcinoma (HCC) patients with splenic arterial embolization (SAE) and to deal with SAE′s complications]Methods 20 patients underwent normal Seldinger method for SAE. Blood platelets were 1 9×10 9/L～4 9×10 9/L before operation. Ten patients received simultaneous SAE and HAE (hepatic arterial embolization). Two underwent SAE and PEIT (percutaneous ethanol intra tumor injection). Seven were treated by SAE after hepatectomy. One was done with SAE before hepatectomy. Single SAE was given in 15 cases, twice in 4, and 3 times in one. Results lood platelets increased nearly 2 times as much five days after SAE. On the seventh day, blood platelets returned to normal. Major complications included fever(14 patients), left upper abdominal pain(20 patients). All 20 patients were alive on the average follow up of 9 6 months.Conclusion SAE is a relatively safe procedure and a highly effective means relieving hypersplenism controllable complications. Patients may be exempt from splenectomy, splenic immune function is thus retained.