肝动脉栓塞化疗并部分性脾栓塞治疗肝癌脾功能亢进的临床探讨

目的:探讨肝动脉栓塞化疗与部分性脾栓塞(PSE)联合应用对肝癌患者脾功能亢进的治疗价值。方法:对肝癌合并脾功能亢进患者18例行肝动脉栓塞化疗并PSE治疗,PSE采用明胶海绵颗粒,超选择性对脾动脉主干远端的分支进行栓塞。随访观察PSE术后反应及外周血象、CT、内镜所见,并经统计学处理。结果:18例行PSE28例次,栓塞范围40%～70%。术后2周外周血白细胞、血小板计数明显升高(P<0.05),末次栓塞6个月后白细胞维持在正常值12例,血小板维持在正常值15例。术后内镜所见胃底食管静脉曲张明显减轻,患者食欲及体能有不同程度改善。28例次行PSE后均出现发热,27例次出现左上腹痛,4例次呃逆,2例次少量胸腔积液,均经保守治疗消失。结论:PSE能有效改善肝癌合并脾功能亢进患者外周血象,增强体能和免疫力,预防上消化道出血,与肝动脉栓塞化疗联合应用,能延长生存期,提高生活质量。

Clinical study on hepatic artery embolization chemotherapy combining partial splenic embolization to treat hepatic cancer with hypersplenism

Objective To evaluate the clinical treatment value of combining application in hepatic artery embolization chemotherapy(TACE) and partial splenic embolization(PSE) to treat hepatocellulocarcinoma with hypersplenism. Method 18 patients of hepatocellulocarcinoma with hypersplenism were treated with TACE and PSE. PSE using gelfoam cubes in optional splenic artery embolization, we serveyed and observed the postoperative reaction peripheral blood cells counts,CT,and endoscopy by statistics. Results 18 patients treated by PSE for 28 times, the embolizic range was 40%～70%. Two weeks later postoperation the peripheral blood WBC and PLT count increased obviously(P<0.05). 12 patients' WBC kept normal after six months being embolized the latest time. 15 patients' PLT kept normal. We saw the remission of fundus of stomach and esophagus varix by endoscopy postoperation, we also saw the improvement on appetite and vigor. 28 times of fever treated by PSE, 27 times of bellyache, 4 times of eructation, 2 times of a little thoracic cavity hydrops, and all the symptoms disappeared after treatment. Conclusion PSE has the effect of increasing blood cells counts and elevating immunity and proventing upper digestive tract hemorrhage. Combining with TACE, it can prolong life and improve living quality.