肝癌合并脾亢行肝脾动脉联合栓塞治疗的临床价值

目的评价肝脾动脉联合栓塞治疗在肝细胞癌合并脾亢中的临床价值。方法62例肝细胞癌合并脾亢患者，其中32例肝动脉化疗栓塞同时行脾动脉栓塞治疗为治疗组，30例单纯行肝动脉化疗栓塞为对照组。采集2组术前术后资料，包括外周血象、CT、上消化道内窥镜或气钡双重造影所见，并对照2组外周血象及食道胃底静脉曲张情况进行统计学处理、分析。结果治疗组肝动脉化疗栓塞72例次，脾动脉部分栓塞1～3次共51例次，脾栓塞范围40％～70％；对照组单纯肝动脉化疗栓塞治疗67例次。治疗组栓塞治疗一般1～3次，至末期栓塞3个月后，血象大多维持在正常范围内，有效保证了化疗栓塞治疗的安全性和有效性；而对照组栓塞后一周至半月血象开始下降，虽进行中西医等综合治疗，大部分很难进行再次化疗栓塞。治疗期间2组血象变化对比显著（P〈0.01）。治疗组栓塞术前后对比静脉曲张程度均有不同程度减轻，以曲张程度较轻的改善更明显一些；而对照组静脉曲张程度反而有加重趋势。2组食道胃底静脉曲张改善对比明显（P〈0.05）。结论肝细胞癌合并脾亢治疗组栓塞治疗较对照组不仅减低了门脉压及脾窦淤血，减轻了脾纤维化，改善脾功能，提高了机体免疫力，提高了生活质量及生存期，降低了肝癌合并脾亢介入治疗的风险，从而有效保证了化疗栓塞的安全性、有效性、合理性。

The Clinic Value of TACE combined with PSE in Treatment of Hepatic Carcinoma with Hypersplenism

Objective This article is mainly to evaluate the clinic value of TACE combined with PSE in treating hepatic carcinoma associated with hypersplenism. Methods： There were 62 cases of hepatic carcinoma with hypersplenism, of which 32 cases were in treating group with treatment of TACE with PSE, and 30 samples were in contrast group with treatment of simple TACE. Information before and after treatment was collected for the 2 groups, including peripheral hemogram, CT, and upper digestive tract endoscope or gas-bariun double contrast radiography. Besides, comparison of peripheral hemogram and gastroes ophageal varices between two groups was carried with means of statistic and analysis. Results： there were 72 TACE cases/times, 51 PSE cases/times （being treated 1 to 3 times） in treating group, which the scope of embolization was from 40% to 70%. Besides, in contrast group, there were 62 simple TAE cases/times. Generally, embolization in treating group was divided into 3 times, and the peripheral hemograrn reached normal value after 3 months of the final stage of treatment, which has ensured the security and effectiveness of embolization. In contrast group, however, one week or half a month after embolization, peripheral hemogram started to drop： Though, Chinese traditional method and western method were applied to treat, most of the cases could hardly receive chemoembolization （TACE） for the second time. Contrast of peripheral hemogram changes between two groups was obvious （P〈0.01）. Varication was reduced to some extent before and after embolization in treating group with the obvious sign being slight varication reduced. However, the situation of varication in contrast group turned to severer. Gastroes ophageal varices change in both groups was obvious （P〈0.05）. Conclusions： comparing with contrast group, the treating group not only could reduce portal pressure and congestion of splenic sinus and splenic fibrosis, but also could improve the function of spleen and capacity of immunity, even im