【摘要】 目的回顾性评价肝癌合并脾功能亢进超选择性肿瘤滋养动脉化疗栓塞联合部分性脾栓塞的安全性及临床疗效。方法对30例肝硬化合并肝癌、门静脉高压及脾功能亢进患者首先实施肝癌肿瘤滋养动脉超选择性化疗栓塞,联合以明胶海绵颗粒进行超选择性部分性脾动脉栓塞治疗,脾栓塞量60%~70%。术后2、7、14、30d复查血常规,4~6周进行CT复查,3、6、12个月进行CT或MRI复查。结果30例术前肝癌直径3~12cm,平均8.5cm;30例全血细胞尤其是血小板及白细胞显著减低。术后24h,WBC 30例明显升高(21例基本正常),血小板略微升高5例、无明显改变25例。术后7d,白细胞基本正常28例、略低于正常2例,血小板明显升高30例(25例基本正常)。1个月左右CT复查,肝癌平均直径5.5cm,肿瘤内碘油完全充填23例、充填≥80%7例;脾实质梗死面积达70%21例、50%9例。所有患者无脾脓肿等严重并发症发生。结论肝癌合并脾功能亢进实施超选择性肿瘤滋养动脉化疗栓塞及部分性脾动脉栓塞安全性较高,在栓塞肝肿瘤同时可减少脾功能亢进及降低门静脉高压,可明显提高患者的生活质量。更多还原

【Abstract】 Objective To retrospectively evaluate effectiveness and safety of ultraselective transcatheter arterial chemoembolization(TACE) combined with partial splenic embolization(PSE) in treating primary hepatocellullar carcinoma with hypersplensim.MethodsThrity HCC patients with liver cirrhosis,portal hypertension and hypersplensim were treated with TACE and PSE,Gelfoam sponge was used as the embolic material for PSE,the area of embolization was arround 70% in PSE.After operation,the blood routine reexamination was carried out on the 2,7,14,30th day,after 4-6th week reexamination CT,after 3,6,12th month reexamination CT or MRI.ResultsBefore operation,the diameter of cancer were 3-12cm in 30 cases HCC,average diameter was 8.5cm.Whole blood cells was reduced especially PLT and WBC reduce more obviously in 30 cases.After 24h,WBC was obviously increase in 30 cases,was essence normal in 21 cases;PLT was little increase in 5 cases,not change in 25 cases.After 7d,WBC was essence normal in 28 cases,was little reduce in 2 cases;PLT was obviously increase in 30 cases,essence normal in 25 cases.Reexamination CT after 1 month,the average diameter of cancer was 5.5cm,cancer was full filled by lipiodol in 23 cases,was filled more 80 percent in 7 cases.The area was 70 per and 50 per was 21 and 9 cases,Necrosis was found in spleen parrenchyma in all cases.There were no servere complications such as splenic abscesses.ConclusionTACE combined with PSE is a safe and effective measure to treat HCC with liver cirrhosis,portal hypertension,and hypersplenism may obvously add quality of life for the patients.更多还原