脾功能亢进三维适形放疗34例疗效观察

目的评价脾功能亢进三维适形放疗的疗效及临床意义。方法将义马煤业集团公司总医院符合诊断标准的65例脾大、脾功能亢进患者随机分为适形放疗组34例和介入治疗组31例。适形放疗组（治疗组）采用三维适形放疗，DT30Gy／15f，常规分割；介入治疗组（对照组）进行脾动脉栓塞术。比较两组治疗前后血常规及脾脏的变化以及治疗后两组不良反应的发生情况。结果①血常规：放疗组放疗前与放疗后WBC、PLT比较差异有统计学意义（P〈0．05）。对照组治疗前与治疗后WBC比较差异有统计学意义（P〈0．05）。两组治疗后WBC、PLT均升至正常范围，两组比较差异无统计学意义（P〉0．05）。②脾脏大小：放疗组治疗前脾脏大小与治疗4周后脾脏大小比较差异有统计学意义（P〈0．05）。介入组治疗前脾脏大小与治疗前后比较差异有统计学意义（P〈0．05）。但治疗后两组比较差异无统计学意义（P〉0．05）。③不良反应：治疗组出现轻度恶心6例，治疗期间4例出现白细胞曾轻度较治疗前下降，但比较稳定未处理后逐渐上升；脾区不适3例。对照组出现左上腹疼痛20例，其中4例患者疼痛剧烈，经注射止痛剂后症状减轻或消失；发热4例，脾脓肿1例。结论三维适行放疗可治疗脾大、脾功能亢进引起的白细胞和血小板减少，疗效确切，与介入治疗相比疗效相当，但不良反应更小，是一种安全、有效的方法，值得临床推广应用。

Observation of curative effect of three-dimensional conformal radiotherapy in 34 patients with hypersplenism

Objective To evaluate the therapeutic effect and clinical significance of three dimensional conformal radiotherapy （3DCRT） on hypersplenism. Methods Sixty-five cases of hypersplenism were randomly divided into 3 DCRT group （34 cases） and interventional therapy group （control group, 31 cases）. Patients in 3 DCRT group （treatment group） were given three-dimen- sional conformal radiotherapy, DT 30 Gy/15 f, conventional fractionation. Patients in control group were given splenic artery em- bolization. The changes of blood RT and spleen side in two groups before and after treatment were compared, and the side effects after treatment in two groups were observed. Results Blood RT： 3DCRT group： WBC （2. 67 ±1.15） x 109/L, RBC （3.35 ± 1.15） ×10^2/L, HGB（102. 15 ± 14.51）g/L, PLT（48.59 ± 19.56） ×10^9/L before radiotherapy; And（4.47 ±1.00） 109/L, （3.74 ±1.17 ） x 1012/L, （ 105.36 ± 15.87）g/L, （95.54 ±17.65 ） . 109/L after raiotherapy, respectively. 3DCRT group showed significant difference in WBC and PLT before and after radiotherapy （ P 〈 0. 05 ）. Control group ： WBC （ 2. 52 ± 0. 59） . 109/L, RBC （3.64 ± 1.06） × 10^12/L, HGB （ 103 ± 5 ） g/L, PLT （41.16 ±6. 21 ） × 10^9/L before treatment; and （3.99 ± 0. 57） ×10^9/L, （3.47 ± 0. 95） ×10^2/L, （ 103.56 ± 15.12） g/L, （ 87.35 ±7.64） × 10^9/L after treatment, respectively. The difference was statistically significant in WBC and PLT before and after treatment（ P 〈 0. 05）, but there was not sig- nificant difference after treatment in WBC and PLT between the two groups （ P 〉 0. 05 ）.②The size of the spleen ： the length of spleen was （ 18.08 ± 1.64） cm, the width was （6. 88 ± 0. 84 ） cm for radiotherapy group before treatment, After 4 weeks of treatment,the length was（ 12. 33 ± 1.49）cm,the width was（4. 04 ±0. 88）cm. 3DCRT group showed significant differences in length and width of spleen before and after radiotherapy （ P 〈 0. 05 ）. The spleen length was （ 17.76 ± 0. 50） cm, the width was （6. 88 ± 0. 75）cm for control group before treatment; After treatment, the length was （11.82 ± 0. 50 ）cm, the width was （4. 35± 0. 51 ）cm. Compared before and after interventional treatment, there were significant differences （P 〈 0. 05 ）, the volumes of spleen were significantly reduced after treatment in two groups. There was no significant difference after treatment between the two groups（P 〉0. 05）. @Side effect： mild nausea occurred in 6 cases of 3DCRT group; During treatment, 4 cases had mild white blood cells decrease followed by gradual rise; Splenic disomfort in 3 cases. Left upper abdominal pain occurred in 20 cases of the control group, there were 4 patients with severe pain, and relieved or disappeared after injection of analgesics; 4 cases had fever, 1 case had splenic abscess. Conclusion Three-dimensional conformal radiotherapy can treat splenomegaly and hyper- splenism induced leukopenia and thrombocytopenia, the curative effect is exact. Compared with interventional treatment, the clinical effect is similar, but side effects are smaller. Three dimensional conformal radiotherapy is a safe and effective method, and is worth promoting in clinics.