肝脾双介入疗法在原发性肝癌伴脾功能亢进中的应用(附35例报告)

目的探讨肝脾双介入疗法在原发性肝癌伴脾功能亢进(简称脾亢)中的应用价值.方法对35例患者采用Seldinger方法,将5FRH导管插入肝固有动脉,灌注化疗药物总量的2/3;注入栓塞剂,置换脾管,插入脾动脉,灌注化疗药物总量的1/3;超选至脾动脉下级分支注入凝胶海绵.化疗应用联合方案:5-氟脲嘧啶(5下U)1000mg、表阿霉素(EADM)60mg、羟基喜树碱(HCPT)30mg或丝裂霉素(MMC)8mg,10例患者加用顺铂(DDP)60mg.栓塞剂为超液化碘油及凝胶海绵.结果30例患者术后4周内白细胞计数为(4.5±2.3)×109/L,血小板计数为(102.1±5.4)×109/L,与术前平均值(2.9×109/Lvs 41.6×109/L)比较有显著性差异.本组患者6个月生存率为100%,1年生存率为60%.35例中完全缓解(CR)1例,部分缓解(PR)10例,稳定(SD)8例,进展(PD)15例,死亡1例.治疗后的不良反应均为发热,6例肝功能异常.结论肝脾双介入疗法可以缓解脾亢,有效支持原发性肝癌的药物治疗.

The liver and spleen interventional therapy for primary carcinoma of the liver with hyperspleenism

Objective To study the value of the liver and spleen interventional therapy in primary carcinoma of the liver with hyperspleenism. Methods The treatment was given to 35 patients. Using the method of Seldinger, we inserted the 5FRH into artery hepatica propria to infuse 2/3 of the overall dose of chemotherapy medicine and embolism in the liver segment. Then infuse 1/3 into artery lienalis and infuse gelatin sponge to artery lienalis Rr. lienales. Combined regimens were used in chemotherapy: 5-Fu 1000mg, EADM 60mg, HCPT 30mg or MMC 8mg, and 10 of the 35 added DDP 60mg. LUF and gelatin sponge were used for embolisation. Results Of the 35 patients the WBC and PLT increased in 30 patients 4 weeks after the operation. The difference was significant. The survival rate at 6 and 12 months was 100% and 60% respectively with 1 case of CR, 10 cases of PR and 8 cases of SD. Patients had fever after the treatment but few with abnormal liver function tests. Conclusions Liver and spleen interventional therapy may relieve hyperspleenism and suggests that the treatment of primary carcinoma of the liver is effective.