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目的探讨射频消融(RFA)脾脏治疗门静脉高压性脾功能亢进症(脾亢)的可行性、有效性和临床应用前景。方法对28例肝硬变、门静脉高压性脾亢患者实施脾脏RFA治疗,对随访1年的9例患者进行实验室数据和影像资料分析。结果9例接受RFA治疗的患者随访时间超过1年。住院治疗期间无操作相关死亡率,主要并发症是胸腔积液(3/9)和轻微腹痛(4/9)。每次操作平均毁损30.7%(20%～43%)脾脏体积,血小板计数于术后14d达到峰值。随访期间白细胞和血小板计数、肝功能以及肝动脉血流量得到显著改善,并发生硬化肝脏增生的现象。结论RFA是治疗门静脉高压性脾亢安全、有效的微创手段。肝动脉血流量增加能明显改善肝脏功能,并可能诱导肝脏再生。
Objective To investigate the feasibility, efficacy and clinical application of radiofrequency ablation (RFA) spleen in the treatment of portal hypertensive hypersplenism (hypersplenism). Methods Splenic RFA was performed on 28 patients with cirrhosis and portal hypertensive hypersplenism. Nine patients who were followed up for one year were analyzed by laboratory data and imaging data. Results Nine patients who received RFA were followed up for more than 1 year. There was no operative-related mortality during hospitalization and the main complications were pleural effusion (3/9) and mild abdominal pain (4/9). The average volume of spleen was 30.7% (20% -43%) per operation, and the platelet count peaked at 14 days after operation. Leukocyte and platelet counts, liver function, and hepatic artery blood flow were significantly improved during follow-up, and cirrhosis of the liver was observed. Conclusion RFA is a safe and effective means of minimally invasive portal hypertensive hypersplenism. Hepatic arterial blood flow can significantly improve liver function, and may induce liver regeneration.