脾动脉栓塞术对肝癌伴脾亢患者免疫功能的影响  

Impact of splenectomy partial splenic embolization on immune function in patients with hepatocellular carcinoma and hypersplenism

作　　者：马立辉[1] 周健[2] 史丽民[1] 胡大为[1] 王助新[1] 崔亮[1] 

机构地区：[1]承德医学院附属医院肿瘤外科,河北省承德市067000 [2]承德医学院附属医院老年病科,河北省承德市067000

出　　处：《世界华人消化杂志》2010年第7期669-675,共7页World Chinese Journal of Digestology

摘　　要：目的:研究脾切除及部分脾动脉栓塞术(PSE)对肝癌伴脾亢患者免疫功能的影响.方法:前瞻性研究肝癌合并脾亢的患者69例,全部经过影像学及实验室检查证实为肝癌合并脾亢,随机分为两组,其中PSE组37例,脾切除组32例.PSE组实施肝癌介入治疗同时行PSE(双介入)治疗,脾切除组实施肝癌介入治疗同时行外科切脾.观察两组术前术后的外周血象、免疫系统指标及临床症状体征的变化.结果:在PSE组,术后测WBC、PLT,与术前比较均有显著性差异(P<0.05);术后测RBC与术前相比无显著差异(P>0.05).在脾切除组,术后测WBC、PLT,与术前比较均有显著性差异(P<0.05);术后测RBC与术前相比无显著差异(P>0.05).术前测PSE组与脾切除组的CD4+、CD4+/CD8+,两组间无显著差异,术后7d、术后28d测CD4+,两组间有显著差异(t=16.063,9.409,P<0.05).术后7d、术后28d测CD4+/CD8+,两组间有显著差异(t=2.060,2.228,P<0.05).在PSE组,术后测CD4+、CD4+/CD8+分别与术前比较,均有显著性差异(P<0.05).在脾切除组,术后测CD4+、CD4+/CD8+分别与术前比较,均无显著性差异(P>0.05).两组病例术后并发症(发热、腹痛、腹水、胸腔积液)发生率的比较均无显著性差异(P>0.05).结论:PSE与传统脾切除术相比,有操作简单、并发症少、术后细胞免疫功能改善等优点,取得了更好的临床治疗效果.AIM： To investigate the impact of splenectomy and partial splenic embolization （PSE） on immune function in patients with hepatocellular carcinoma and hypersplenism. METHODS： A prospective study was performed. Sixty-nine patient clinically diagnosed as liver cancer with hypersplenism were randomly divided into two groups： PSE group （n = 37） and splenectomy group （n = 32）. The PSE group underwent PSE and transcatheter arterial chemoembolization （TACE）, while the splenectomy group underwent splenectomy and TACE. Before and after treatment, blood routine exami-nation was performed, and immunologic parameters were determined in both groups. The complications associated with treatment were also observed. RESULTS： In the PSE group, significant differences were noted in WBC and PLT （both P 0.05） but not in RBC （P 0.05） between before and after treatment. Similar results were also obtained in the splenectomy group. No significant differences were found in preoperative CD4 ＋ lympho- cyte percentage and CD4 ＋ /CD8 ＋ ratio between the PSE group and the splenectomy group. However, significant differences were noted in CD4 ＋ lymphocyte percentage and CD4 ＋ /CD8 ＋ ratio 7 and 28 days after treatment （CD4 ＋ ： t = 16.063 and 9.409, both P 0.05; CD4 ＋ /CD8 ＋ ： t = 2.060 and 2.228, both P 0.05）. Significant dif- ferences were noted between preoperative and postoperative CD4 ＋ lymphocyte percentage and CD4 ＋ /CD8 ＋ ratio in the PSE group （all P 0.05） but not in the splenectomy group （all P 0.05）. There is no significant difference in the incidence of complications （such as fever, abdominal pain, ascites, and pleural effusion） between the two groups （P 0.05）. CONCLUSION： PSE has several advantages over splenectomy in the treatment of hepatocellular carcinoma with hypersplenism, including simpleness, fewer complications, and being able to improve cellular immune function.

关 键 词：肝癌 脾功能亢进 部分脾栓塞术 脾切除 免疫功能 

分 类 号：R735.7[医药卫生—肿瘤]