肝动脉介入联合栓塞在肝癌合并脾功能亢进患者中的应用  

Application of hepatic artery intervention combined with embolization in patients with liver cancer complicated by hypersplenism

作　　者：祝德[1] 张军旗[1] 杨俊 雷乃军 ZHU De;ZHANG Junqi;YANG Jun;LEI Naijun(Department of Oncology,Central Hospital of Bazhong,Bazhong,Sichuan,China,636000)

机构地区：[1]四川省巴中市中心医院肿瘤科,四川巴中636000

出　　处：《分子诊断与治疗杂志》2022年第3期503-506,511,共5页Journal of Molecular Diagnostics and Therapy

基　　金：巴中市科技支撑计划项目(2018-22015)。

摘　　要：目的探究肝动脉介入联合脾动脉栓塞对肝癌合并脾功能亢进患者门静脉血流动力学及T淋巴细胞亚群的影响。方法选取巴中市中心医院2016年7月至2019年7月收治的104例肝癌合并脾功能亢进患者,按照随机数字表法分为两组,各52例。对照组给予肝动脉介入栓塞治疗,观察组给予肝动脉介入联合脾动脉栓塞治疗。比较两组术前、术后7 d外周血白细胞、血小板计数、肝功能指标[谷丙转氨酶(ALT)、总胆红素(TBIL)]、门静脉血流动力学(门静脉直径、门静脉对比剂达峰时间)、T淋巴细胞亚群(CD4^(+)、CD4^(+)/CD8^(+))、血清肿瘤标志物[高尔基体糖蛋白73(GP73)、甲胎蛋白异质体-L3(AFP-L3)、转化生长因子-β1(TGF-β1)]及并发症发生情况。结果术后7 d观察组外周血白细胞、血小板计数高于对照组,血清ALT、TBIL低于对照组,门静脉对比剂达峰时间、门静脉直径短于对照组,差异均有统计学意义(P<0.05);观察组术后7 d CD4^(+)、CD4^(+)/CD8^(+)高于对照组,血清AFP-L3、GP73、TGF-β1低于对照组,差异均有统计学意义(P<0.05);两组腹水、胸腔积液、门静脉血栓发生率相比,差异无统计学意义(P>0.05)。结论肝动脉介入联合脾动脉栓塞治疗肝癌合并脾功能亢进能有效减轻患者脾功能亢进级肝功能损害,改善门静脉血流动力学及机体免疫功能,降低肿瘤标志物水平,且安全性高。Objective To investigate the effect of hepatic artery intervention combined with splenic artery embolization on portal vein hemodynamics and T lymphocyte subsets in patients with liver cancer complicated with hypersplenism.Methods A total of 104 patients with hepatocellular carcinoma and hypersplenism admitted from July 2016 to July 2019 in Central Hospital of Bazhong were selected and divided into two groups according to the random number table method,52 cases each.The control group was given hepatic artery interventional embolization,and the observation group was given hepatic artery intervention and splenic artery embolization.The peripheral blood leukocytes,platelet count,liver function indexes[alanine aminotransferase(ALT),total bilirubin(TBIL)],portal vein hemodynamics(portal vein diameter,portal vein contrast agent peak time),T lymphocyte subsets(CD4^(+),CD4^(+)/CD8^(+)),serum tumor markers[Golgi glycoprotein 73(GP73),alpha-fetoprotein heterogeneity-L3(AFP-L3),transforming growth factor-β1(TGF-β1)],and the occurrence of complications before and 7 days after operation were compared between the two groups.Results On the 7th day after operation,the peripheral blood leukocyte and platelet counts in the observation group were higher than those in the control group,the serum ALT and TBIL were lower than those in the control group,the peak time of portal contrast agent and the diameter of the portal vein were shorter than those in the control group,and the differences were statistically significant(P<0.05);7 days after operation,CD4^(+),CD4^(+)/CD8^(+)n the observation group were higher than those in the control group,and serum AFP-L3,GP73,TGF-β1 were lower than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of pleural effusion and portal vein thrombosis(P>0.05).Conclusion Hepatic artery intervention combined with splenic artery embolization in the treatment of liver cancer complicated with hypersplenism can effectively red

关 键 词：肝动脉介入 脾动脉栓塞 肝癌 脾功能亢进 门静脉血流动力学 T淋巴细胞亚群 

分 类 号：R735.7[医药卫生—肿瘤] R551.1[医药卫生—临床医学]