肝癌并发脾功能亢进患者肝脾双介入对肝功能及门静脉血流动力学的影响

Effect of liver and spleen interventional therapy on liver function and portal vein hemodynamics in patients with liver cancer complicated with hypersplenism

目的观察肝癌并发脾功能亢进患者双介入治疗栓塞前后肝功能、血常规、门静脉血流动力学的变化。方法对58例肝癌并发脾功能亢进患者采用微创介入肝癌供血动脉和脾动脉栓塞治疗,于术前、术后3d、术后1周检测白细胞、血小板、丙氨酸转氨酶及胆红素水平。栓塞前后测量门静脉直径和门静脉对比剂达峰时间。结果术后1周外周血白细胞和血小板计数明显高于术前和术后3d(P<0.05),术后3d丙氨酸转氨酶和胆红素明显高于术前,术后1周丙氨酸转氨酶和胆红素明显低于术后3d(P<0.05)。栓塞前后门静脉直径及对比剂达峰时间差异无统计学意义(P>0.05)。结论对肝癌并发脾功能亢进患者采用微创双介入栓塞治疗,既削弱了脾脏破坏血细胞的功能,又保留了部分脾脏的正常免疫功能,提高了血细胞计数,对肝功能损害小,恢复快,减少了患者的感染机会,保证了肝癌患者的后续治疗,具有安全性和有效性。

Objective To investigate the changes of liver function, blood routine and portal vein hemodynamics before and after embolization of hepatosplenic interventional therapy in patients with hepatocellular carcinoma complicated with hypersplenism. Methods A total of 58 patients with hepatocellular carcinoma and hypersplenism were performed with dual interventional therapy of hepatic and splenic ariery chemoembolization. The levels of leukocyte, platelet, alanine aminotransferase and bilirubin were detected in preoperative, on day 3 and one week after the dual interventional.We also observed portal vein diameter and the flow peak time of portal vein blood before and after the embolization. Results The platelet count and the white blood cell count of the patients observed in one week after the embolization were significantly higher than that in patients before and day 3 after the embolization（P〈0.05）. But the levels of alanine aminotransferase and bilirubin of the patients in one week after the interventional therapy were significantly lower than that in patients day 3 after the interventional therapy（P〈0.05）. The diameter of portal vein and the peak time of contrast medium had no significant difference before and after embolization（P〈0.05）. Conclusion The treatment of liver cancer complicated with hypersplenism by minimally invasive double interventional embolization not only Weakens the function of spleen in destroying the blood ceils, but also retains the normal immune function of some spleen, increased blood count. The treatment has the advantages of little damage to the liver function, quick recovery, reducing the infection opportunity of the patient, and ensuring the follow-up treatment of the patients with liver cancer, and has the safety and effectiveness. Minimally invasive Interventional embolization for hepatocellular carcinoma with hypersplenism, not only weakened the function of spleen destruction of blood cells, but also retained some of the normal immune function of the spleen, increased blood cell count, small damage to liver function, rapid recovery, reduced the chance of infection, guaranteed the follow-up treatment of liver cancer patients, has safety and effectiveness.