TACE联合LPSE治疗原发性肝癌伴脾亢的临床研究

Transcather arterial chemoembolization in combination with limited partial splenic embolization in treatment of hepatocellular carcinoma complicated with hypersplenism

目的 探讨经肝动脉插管化疗栓塞 (TACE)联合限制性部分脾栓塞 (LPSE)治疗原发性肝癌伴肝硬化、门脉高压及脾功能亢进的意义和方法。方法 肝癌TACE同时行LPSE治疗原发性肝癌伴肝硬化、门脉高压及脾功能亢进 5 0例 ,根据病人肝功能情况及脾亢程度决定脾脏栓塞范围和次数 ,8例伴重度食管静脉曲张者栓塞前加行静脉套扎术 (EVL)。栓塞后定期复查肝功能和血常规。结果 本组经 1～ 4次LPSE ,累积脾栓塞面积为 30 %～ 70 % ,脾功能亢进完全或部分缓解 ,无脾脓肿等严重并发症。TACE联合LPSE治疗后 1周 ,WBC和PLT有显著提高 (P <0 0 1) ,并能长时间维持在较高水平 ,RBC无明显改变 (P >0 0 5 )。TBIL、ALT和AST升高 ,ALB下降 ,有统计学差异 (P <0 0 5 )。在 8～ 2 6个月随访期内 ,6 ,12 ,18,2 4个月累计生存率分别为 10 0 % ,89% ,71% ,6 3% ,15个月内无上消化道出血发生。结论 TACE联合LPSE是治疗原发性肝癌伴肝硬化、门脉高压及脾功能亢进的安全、有效方法 ,肝癌病人反复多次LPSE能防止脾脏过度栓塞 ,减少并发症 ,更能巩固疗效。

Objective To investigate the value and method of transcatether arterial chemoembolization (TACE) in combination with limited partial splenic embolization (LPSE) in treatment of hepatocellular carcinoma (HCC) complicated with liver cirrhosis, portal hypertension and hypersplenism. Methods TACE in combination with LPSE was concomitantly performed in 50 cases of HCC complicated with liver cirrhosis, portal hypertension and hypersplenism. The area of infarcted splenic parenchyma and duration of LPSE were determined according to the liver function and hypersplenism degree of the patients. Eight of the patients with severe esophageal varices were treated by esophageal varices ligation (EVL) followed by TACE and LPSE. The blood profile and liver function were regularly tested before and after the treatment. Results In all the patients, 30%～70% of splenic parenchyma was infarcted cumulatively by LPSE for 1～4 times. The hypersplenism was completely or partially corrected and no splenic abscesses or other severe complications were found. One week after TACE and LPSE, WBC and PLT counts significantly increased (P<0 01) and lasted for a long time at a relatively high level. No marked changes in RBC counts were found (P>0 05). The levels of TBIL, ALT and AST remarkably rose (P<0 05) while that of ALB markedly decreased (P<0 05). During the follow up period for 8～26 months, the 6 , 12 , 18 and 24 month survival rates of the patients were 100%, 89%, 71% and 63%, respectively. No upper gastrointestinal bleeding occurred in 18 months after the treatment. Conclusions TACE in combination with LPSE is a safe and effective measure for patients with HCC complicated with liver cirrhosis, portal hypertension and hypersplenism. LPSE can prevent over embolization, reduce the complications and maintain the efficacy upon repeated performance.