经皮微波消融治疗38例脾功能亢进的临床研究  

Clinical study on thirty-eight cases of percutaneous microwave ablation in the treatment of hypersplenism

作　　者：江向武[1] 马彦[1] 冯淑芬[1] 刘雪莲[1] 杨冬华[1] 

机构地区：[1]暨南大学附属第一医院消化科,广州510630

出　　处：《中华消化杂志》2014年第8期535-538,共4页Chinese Journal of Digestion

摘　　要：目的 探讨经皮微波消融脾脏治疗脾功能亢进的临床效果和安全性.方法 选取2007年3月至2011年5月慢性乙型肝炎肝硬化继发中重度脾功能亢进患者38例.行经皮分次微波消融治疗前,先经三维CT平扫计算脾脏体积,并行多普勒超声、血常规、尿常规、肝功能、肾功能、血清淀粉酶水平、血清脂肪酶水平检查.第1次操作的消融体积约为初始脾脏的1/3,1周后若无明显并发症,则再次消融1/3初始脾脏体积的脾脏组织.微波消融后第1、3、5天分别行血常规和肝功能检查.微波消融后第7和14天分别行血常规、肝功能、多普勒超声检查.微波消融后第30天行增强CT检查.微波消融后1和3个月,以及之后每3个月行血常规、肝功能、肾功能、血清淀粉酶水平和多普勒超声检查.随访时间＞2年.临床数据的比较采用t检验.结果 消融体积比例为41％～57％,平均为（47±5）％.术前白细胞平均计数为（2.46±0.78）×10^9/L,术后渐升,至术后第3天达峰值[（5.34±2.10）×10^9/L],之后渐下降,术后24个月时为（3.16±1.02）×10^9/L,与术前比较差异有统计学意义（t＝-3.349,P＜0.01）.术前血小板计数为（46.58±17.30）×10^9/L,术后渐下降,至术后第3天达最低点,之后开始上升,于术后30 d内达峰值[（101.79±25.80）×10^9/L],之后渐下降,术后24个月时为（61.97±15.09）×10^9/L,与术前比较差异有统计学意义（t＝-4.135,P＜0.01）.术前门静脉平均内径为（14.66±0.88） mm,术后3个月时为（13.22±0.64） mm,与术前比较差异有统计学意义（t=8.145,P＜0.01）,术后6个月时为（14.64±0.81） mm,与术前比较差异无统计学意义（P＞0.05）.主要不良反应为发热、左上腹痛、左肩痛、胸腔积液、腹腔出血、短时血红蛋白尿,对症治疗后均恢复.未发生无法控制的出血、脾脓肿、脾破裂、周围器官损伤等严重并发症或治疗相关的死亡.结论 经皮分次微波消融�Objective To investigate the efficacy and safety of percutaneous microwave ablation in the treatment of hypersplenism.Methods From March 2007 to May 2011,38 patients with hepatitis B virus caused liver cirrhosis and complicated with hypersplenism received percutaneous microwave ablation treatment for several times.Before percutaneous microwave ablation treatment,the volume of spleen was calculated according to 3D computed tomography （CT） scan.Ultrasound,blood routine,urine routine,liver function test,kidney function test,serum amylase and lipase were also tested.For the first time,1/3 volume of spleen was ablated.If no complication were observed in one week after ablation,then another 1/3 volume of spleen was ablated.Blood routine and liver function test were checked on the 1st,3rd and 5th day after microwave ablation.Blood routine,liver function test and ultrasound were examined on 7th and 14th day after microwave ablation.On the 30th day CT examination was conducted.Ultrasound,blood routine,urine routine,liver function test,kidney function test,serum amylase and lipase were detected at one month,three month and every three month after microwave ablation.The follow up duration was over two years.The t-test was performed for clinical data comparison.Results The mean ratio of ablated spleen was （47 ±5）% （range 41% to 57%）.Preoperative white blood cell count was （2.46±0.78）× 10^9/L,which gradually increased after operation and peaked on the 3rd day after operation （（5.34 ± 2.10） × 10^9/L）.Then gradually decreased,which was （3.16 ± 1.02） × 10^9/L at 24 month and the difference was statistically significant compared with that of preoperation （t=-3.349,P〈0.01）.Preoperative platelet count was （46.58 ± 17.30） × 10^9/L,which gradually decreased after operation and was lowest on the 3rd day after operation.Then gradually increased,which peaked at 30 days after operation （（101.79 ± 25.80） × 10^9/L） and then gradually decreased,which was （61.97 ± 15.09） × 10^9/L

关 键 词：微波消融 脾功能亢进症 疗效 

分 类 号：R657.63[医药卫生—外科学]