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目的 评价联合应用肝动脉栓塞灌注化疗和部分性脾栓塞治疗肝癌患者脾功能亢进的临床价值。方法 收集原发性肝细胞癌合并门脉高压患者 110例 ,经导管动脉栓塞 (TACE)同时行部分性脾栓塞 ,分 1～ 3次达到控制目的。脾栓塞采用 35 5～ 5 0 0 μmPVA微粒 ,脾下极动脉超选部分性脾栓塞。采集每次脾栓塞术前、术后资料 ,包括症状、体征、外周血象、增强CT ,上消化道内镜所见 ,并进行统计学处理、分析。结果 共行部分性脾栓塞 172例次。栓塞范围 30 %～ 6 0 %。栓塞后有 134例次出现发热 ,持续 3～ 30d ,12 6例次出现腹痛 ,其中 2 7例次需用强效止痛药物。少量胸腔积液 6例次 ,保守治疗后消失。未出现脾脓肿等严重并发症。术后 2 4h外周血白细胞、血小板计数 (BPC)开始升高 (P <0 .0 5 ) ,末次栓塞后 3个月白细胞维持在正常值为 6 7例 ,BPC维持在正常值为 82例。术后食欲、体能以及胃底食管静脉曲张均有所改善。结论 部分性脾栓塞治疗肝癌合并脾功能亢进能有效改善血象 ,提高机体免疫力 ,提高生活质量。
Objective To evaluate the clinical value of combined use of hepatic artery embolization chemotherapy and partial splenic embolization in the treatment of hypersplenism in patients with liver cancer. Methods A total of 110 patients with primary hepatocellular carcinoma and portal hypertension were collected. Transcatheter arterial embolization (TACE) was performed simultaneously with partial splenic embolization. Controls were performed 1 to 3 times. Splenic embolization was performed using 35-500 μm PVA microparticles. Partial splenic embolization was performed in the inferior splenic artery. The preoperative and postoperative data of each spleen embolization were collected, including symptoms, signs, peripheral blood, enhanced CT, and upper gastrointestinal endoscopy findings, and statistical analysis and analysis were performed. Results A total of 172 cases of partial splenic embolism were performed. The embolization range is 30% to 60%. There were 134 cases of fever after embolization, lasting 3 to 30 days, and 126 cases had abdominal pain. Among them, 27 cases required strong painkillers. A small amount of pleural effusion occurred in 6 cases and disappeared after conservative treatment. There were no serious complications such as splenic abscesses. The peripheral blood leukocytes and platelet count (BPC) began to increase (P<0.05) at 24 hours after operation, and the normal value of white blood cells remained at 67 cases in the 3 months after the last embolization. The BPC remained at the normal value of 82 cases. Postoperative appetite, physical fitness, and gastric esophageal varices improved. Conclusion Partial splenic embolization in the treatment of hepatocellular carcinoma with hypersplenism can effectively improve the blood picture, improve the body immunity, and improve the quality of life.