经皮射频消融治疗门静脉高压性脾功能亢进的临床研究

Percutaneous radiofrequency ablation for the treatment of hypersplenism due to portal hypertension:a clinical study

目的：探讨B型超声/CT导引下经皮穿刺多极电极射频消融（RFA）治疗肝硬化门脉高压性脾功能亢进症（脾亢）的可行性、疗效和临床应用前景。方法对28例门静脉高压性脾亢患者进行经皮RFA治疗。检测并比较患者术前以及术后2d，2周以及1、3、6、10个月各时间点血常规、肝功能、凝血酶原时间；于术后即刻、1周，和1、3、10个月复查增强CT，采用CT后处理软件计算消融灶体积。结果平均手术时间为（3.8±1.1）h，平均消融时间为（2.7±0.8）h；RFA毁损范围占脾脏总体积20%～80%，平均为（50.5±10.3）%；术后2d外周血小板计数较术前明显下降[（19.5±12.1）×109/L]，白细胞计数达到最高峰[（5.4±0.2）×109/L]；术后2周直至随访10个月时白细胞和血小板计数、肝功能以及凝血功能均较术前显著改善，差异有统计学意义（P＜0.05），并发生硬化肝脏增生的现象，所有病例Child-Pugh评分均为A级。仅1例大量腹水的Child-PughC级患者术后出现腹胀和血性腹水，无其他严重并发症。结论经皮B型超声/CT导向下RFA治疗门静脉高压性脾功能亢进是一种安全、有效的微创方法。

Objective To evaluate the feasibility, effectiveness and clinical application of B ultrasound/CT-guided percutaneous radiofrequency ablation （RFA） in treating hypersplenism due to portal hypertension. Methods B ultrasound/CT-guided percutaneous radiofrequency ablation was carried out in 28 patients with hypersplenism associated with portal hypertension. Routine blood counts, liver functions and prothrombin time were determined before RFA and 2 days, 2 weeks, one, 3, 6 and 10 months after RFA separately. The results were analyzed and compared. Enhanced CT scanning reexamination was performed immediately after RFA and one week, one, 3 and 10 months after RFA separately. The volume of ablated spleen tissue was calculated with CT post-processing software. Results The mean operation time was （3.8 ± 1.1） hours and the mean ablation time was （2.7 ± 0.8） hours. The ablated volume of the spleen accounted for 20% - 80% of the whole spleen, with a mean of 50.5% ± 10.3%. Two days after RFA, the platelet count decreased to （19.5 ± 12.1） × 109/L, while the white blood cell count reached its peak value of （5.4＋0.2） × 109. From two weeks to 10 months after RFA the white blood cell counts and platelet counts, the liver function, and the prothrombin time were significantly improved when compared with preoperative ones, and the differences were statistically significant （P 〈 0.05）. Pathologically, hepatic proliferation could be seen within the cirrhotic liver after RFA. Child-Pugh score was grade A in all patients except one patient with Child-Pugh grade C who developed abdominal distention and bloody ascites after RFA. No other severe complications occurred. Conclusion For hypersplenism due to portal hypertension, B ultrasound/CT-guided percutaneous radiofrequency ablation is a safe, effective and minimally - invasive treatment.