三维适形放疗与介入疗法治疗肝源性脾功能亢进45例

Three dimensional conformal radiotherapy versus interventional therapy for hepatogenic hypersplenism: an analysis of 45 case

目的比较三维适形放疗及介入方法治疗脾功能亢进(脾亢)的疗效、不良反应。方法回顾性分析安徽医科大学附属安庆医院2010年5月至2016年5月脾亢伴血小板减少症或白细胞减少症患者45例,其中25例采用三维适形放射治疗,20例采用介入治疗。采用重复测量方差分析方法判断不同组别随着时间的变化对研究对象脾脏大小、血常规指标的影响。结果时间因素对脾脏长度及深度的影响差异有统计学意义(F=3.181,P=0.046;F=4.162,P=0.037);组别对脾脏长度及深度的影响差异无统计学意义(F=0.793,P=0.378;F=3.932,P=0.054);治疗后,放疗组/介入组的白细胞计数(×10~9·L^(-1))为(6.02±1.56)/(5.15±1.52)及血小板计数(×10~9·L^(-1))为(100.97±77.83)/(95.06±44.38)、血红蛋白水平(g·L^(-1))为(113.22±9.48)/(124.84±17.2),分别较治疗前显著升高[WBC(×10~9·L^(-1)):(2.64±0.95)/(3.12±1.21),PLT(×10~9·L^(-1)):(42.19±0.42)/(52.47±20.48),HB(g·L^(-1)):(10~9.73±9.21)/(112.45±13.88)](F=99.721,P<0.001;F=17.447,P<0.001;F=8.398,P<0.001),各组外周血细胞计数差异无统计学意义(WBC:F=0.091,P=0.764;PLT:F=0.379,P=0.541;HB:F=2.078,P=0.157)。接受介入治疗患者不良反应发生率为100%,所有患者出现发热、疼痛;三维适形放疗后出现发热有2例(2/25,8%),出现脾区疼痛的有3例(3/25,12%),发生率低于介入组。结论脾亢三维适形放疗可达到和介入治疗相同的疗效,并显著减少不良反应。

Objective To compare the clinical effects,treatment-ralated side effects of three dimensional conformal radiotherapy（ 3 DCRT） and interventional therapy for the treatment of hepatogenic hypersplenism. Methods 45 hypersplenism patients with thrombocybopenia or lenkopenia secondary to liver disease between May 2010 to May 2016 were analyzed retrospectively. 25 patients were treated with 3 DCRT,and 20 patients were treated with interventional therapy. The blood counts and spleen size were evaluated at baseline,before treatment,and at 1 month after treatment and treatment-related complications were recorded. Results The influence of time factor on the length and depth of spleen was statistically significant（ F = 3. 181,P = 0. 046; F = 4. 162,P = 0. 037）; The effect of group on the length and depth of spleen was not statistically significant（ F = 0. 793,P = 0. 378; F = 3. 932,P = 0. 054）; After treatment,The level of WBC（ 10~9·L^-1） 、PLT（ 10~9·L^-1） and HB（ g·L^-1） between radiotherapy and interventional group were as follows：（ 6. 02 ± 1. 56）/（ 5. 15 ± 1. 52）,（ 100. 97 ± 77. 83）/（ 95. 06 ± 44. 38）,（ 113. 22 ± 9. 48）/（ 124. 84 ± 17. 2）,which were significantly higher than that of untreated[WBC（ 10~9·L^-1） ：（ 2. 64 ± 0. 95）/（ 3. 12 ± 1. 21）,PLT（ 10~9·L^-1） ：（ 42. 19 ± 0. 42）/（ 52. 47 ± 20. 48）,HB（ g·L^-1） ：（ 10~9. 73 ± 9. 21）/（ 112. 45 ± 13. 88） ]（ F = 99. 721,P〈0. 001; F = 17. 447,P〈0. 001; F = 8. 398,P〈0. 001） and peripheral blood cell count in all groups was not statistically significant（ WBC： F = 0. 091,P = 0. 764; PLT： F =0. 379,P = 0. 541; HB： F = 2. 078,P = 0. 157）. The complication rate was 100% in the interventional therapy group,every patient experienced fever and abdominal pain. Compared to the interventional therapy group,fever（ 2/25,8%） and abdominal pain（ 3/25,12%） were significantly reduced in the 3 DCRT group. Conclusion 3 DCRT can achieve the same curative effects as the interventional therapy and can reduce complications in the treatment of hepatogenic hypersplenism.