自体毛发脾动脉栓塞联合TACE治疗肝癌合并脾功能亢进  

Autologous hair partial splenic embolization in combination with tanscather arterial chemoembolization in treatment of hepatocellular carcinoma complicated with hypersplenism

作　　者：孙春涛[1] 李伟[1] 坚永彬[1] 王振杰[1] 郝刚[1] 

机构地区：[1]潍坊市人民医院介入放射科,山东261041

出　　处：《当代医学》2009年第29期561-563,共3页Contemporary Medicine

摘　　要：目的探讨用患者自体毛发作为栓塞材料行脾动脉栓塞联合TACE治疗肝癌合并肝硬化、门脉高压及脾功能亢进的意义和方法,寻找理想的脾动脉栓塞材料。方法肝癌TACE同时用患者自体毛发做为栓塞材料行PSE治疗原发性肝癌伴肝硬化、门脉高压及脾功能亢进30例,根据病人肝功能情况及脾亢程度决定脾脏栓塞范围和次数。栓塞后定期复查肝功能和血常规。结果本组经1～4次PSE累积脾栓塞面积为30%～70%脾功能亢进完全或部分缓解,无脾脓肿等严重并发症。TACE联合PSE治疗后1周,WBC和PLT有显著提高(P<0.01),并能长时间维持在较高水平,RBC无明显改变(P>0.05)。TBIL、ALT和AST升高,ALB下降,有统计学差异(P<0.05)。在8～24个月随访内,6,12,18,24个月累计生存率分别为100%,85%,76%,62%,15个月内无上消化道出血发生。结论自体毛发脾动脉栓塞联合TACE是治疗原发性肝癌伴肝硬化、门脉高压及脾功能亢进的安全、有效方法,患者自体毛发是一种理想的栓塞材料。Objective To investigate the value and method of autologous hair partial splenic embolization（PSE） in combination with Transcatether Arterial chemoembolization （TACE） in treatment of hepatocellular carcinoma （HCC） complicated with liver cirrhosis, portal hypertension and hypersplenism, and in search of a better splenic embolization material. Methods Autologous hair PSE in combination with TACE was concomitantly performed in 30 cases of HCC complicated with liver cirrhosis, portal hypertension and hypersplenism. The area of infarcted splenic parenchyma and duration of autologous hair PSE were determined according to the liver function and hypersplenism degree of the patients. The blood profile and liver function were regularly tested before and after the treatment. Results In all the patients, 30 % - 70 % of splenic parenchyma was infarcted cumulatively by PSE for 1- 4 times. The hypersplenism was completely or partially corrected and no splenic abscesses or other severe complications were found. One week after TACE and autologous hair PSE, WBC and PLT counts significantly increased（P〈0.01） and lasted for a long time at a relatively high level. No marked changes in RBC counts were found （P〉0.05）. The levels of TBIL, ALT and AST remarkably rose while that of ALB markedly decreased （P 〈0.05）. During the follow-up period for 8-24 months, the 6-,12-,18-,and 24-month survival rates of the patients were 100%, 85%, 76% and 62%, respectively. No upper gastrointestinal bleeding occurred in 15months after the treatment. Conclusions Autologous hair PSE in combination with TACE is a safe and effective measure for patients with HCC complicated with liver cirrhosis, portal hypertension and hypersplenism. Autologous hair is ideal embolic material.

关 键 词：癌 肝细胞 脾功能亢进 门脉高压 插管化疗栓塞 脾栓塞 栓塞剂 

分 类 号：R735.7[医药卫生—肿瘤]