肝动脉插管化疗栓塞与超选择性部分脾动脉栓塞治疗原发性肝癌合并脾动脉亢进  

Efficacy of TACE combined with selective PSE in treating primary hepatocellular carcinoma with hypersplenism

作　　者：付丽云[1] 徐长风[1] 高国生[2] 

机构地区：[1]宁波市第二医院消化三科,浙江宁波315016 [2]宁波市第二医院检验科,浙江宁波315016

出　　处：《中国现代医生》2012年第32期120-123,共4页China Modern Doctor

基　　金：浙江省宁波市自然科学基金项目(2010A610056)

摘　　要：目的观察肝动脉插管化疗栓塞联合超选择性部分脾动脉栓塞术治疗原发性肝癌合并脾动脉亢进患者的疗效。方法回顾性分析38例合并肝硬化、门脉高压、脾功能亢进的原发性肝癌住院患者,均予TACE联合超选择性PSE,观察术前、术后7和14 d的白细胞(WBC)、血红蛋白(Hb)、血小板(PLT)、总胆红素(TBil)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、凝血酶原时间(PT)、白蛋白(Alb)、甲胎蛋白(AFP)、a-岩藻糖苷酶(a-FU)的变化,术前、术后4周肿瘤的平均直径的变化及6、12、18个月的累积生存率。结果采用两种方式的联合治疗,术后第7天及14天WBC、Hb及PLT较术前上升有统计学意义(P<0.05);TBil、ALT、AST术后第7天较术前上升有统计学意义(P<0.05),PT、Alb术后第7天较术前下降有统计学意义(P<0.05),术后第14天TBil、ALT、Alb的变化较术前有统计学意义(P>0.05);AFP、a-FU术后第7天及14天较术前明显下降(P<0.05),术后4周肿瘤平均直径的下降有统计学意义(Z=-10.807,P=0.000),且6、12、18个月的生存率分别为97%、92%、87%。结论肝动脉插管化疗栓塞联合超选择性部分脾动脉栓塞术治疗原发性肝癌并门脉高压、脾功能亢进的患者安全、有效,术后2周内应给予积极的保肝治疗。Objective To observe the effectiveness and safety of transcatheter arteriaI chemo- embolization （TACE） com- bined with selective partial splenic embolization （PSE） in treating primary hepatocellular carcinoma （HCC） with Hyper- splenism. Methods Thirty-eight HCC inpatients with liver cirrhosis,portal hypertension and hypersplenism were treated with TACE and selective PSE. The quantitative result of peripheral white blood cells （WBC）,hemoglobin （Hb）, platelet （PLT）,total biliruhin （TBil）, glutamic-pyruvic transaminase （ALT）, glutamic-oxalacetic transaminase（AST）,prothrombin time （PT）, albumin（Alb）, alpha-fetoprotein（AFP）, a-fucosidase（a-FU）, in preoperatively and seven days, fourteen days after oper- ation respectively, tumor average diameter in preoperative and four weeks after operation and cumulative survival rate after six,twelve ,eighteen months were observed. Results Compared with preoperation the elevation of WBC ,Hb and PLT senven days ,fourteen days after operation had the statistical significance（P 〈 0.05）, the elevation of the TBil,ALT ,AST ,the decli- nation of PT,Alb senven days after operation had the statistical significance （P 〈 0.05）, the variation of TBil ,ALT,Alb fourteen days after operation had statistical significance, the declination of AFP and a-FU senven days,fourteen days after operation had the statistical significance （P 〈 0.05）, the shrinkage of tumor average diameter four weeks after operation had the statistical significance（P 〈 0.05） . with two methods combination ,the cumulative survival rate after six,twelve ,eighteen months were 97%, 92%, 87% respectively. Conclusion TACE combined with PSE is a safe and effective method to treat HCC with liver cirrhosis,portal hypertension and hypersplenism, positive liver treatment should be given within two weeks after operation.

关 键 词：肝癌细胞 肝动脉插管化疗 部分脾动脉栓塞 脾功能亢进 

分 类 号：R735.7[医药卫生—肿瘤]