脾动脉球囊阻断联合脾脏微波消融治疗肝癌合并肝硬化脾功能亢进的疗效与安全性分析  

Analysis of the efficacy and safety of splenic artery balloon occlusion combined with splenic microwave ablation in the treatment of hepatocellular carcinoma complicated with cirrhosis and hypersplenism

作　　者：高欣 欧艳梅 徐勇[1] 张磊 李慧锴 司同国 杨茂 张顺财 李幸 Gao Xin;Ou Yanmei;Xu Yong;Zhang Lei;Li Huikai;Si Tongguo;Yang Mao;Zhang Shuncai;Li Xing(Department of Ultrasound Diagnosis and Treatment,Tianjin Cancer Hospital Airport Hospital,Tianjin 300000,China;Department of Radiology,Tianjin Cancer Hospital Airport Hospital,Tianjin 300000,China;Department of Hepatobiliary Oncology,Tianjin Cancer Hospital Airport Hospital,Tianjin 300000,China;Department of Interventional Therapy,Tianjin Cancer Hospital Airport Hospital,Tianjin 300000,China)

机构地区：[1]天津市肿瘤医院空港医院超声诊疗科,天津300000 [2]天津市肿瘤医院空港医院放射科,天津300000 [3]天津市肿瘤医院空港医院肝胆肿瘤科,天津300000 [4]天津市肿瘤医院空港医院介入治疗科,天津300000

出　　处：《中华肝胆外科杂志》2025年第1期49-53,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的:分析脾动脉球囊阻断联合脾脏微波消融治疗肝癌合并肝硬化脾功能亢进的疗效与安全性。方法:回顾分析天津市肿瘤医院空港医院2023年8月至2024年5月住院治疗的肝癌合并肝硬化脾功能亢进患者资料。共入组24例患者,其中男性13例,女性11例,年龄(57.4±7.8)岁。所有患者均行脾动脉球囊阻断及脾脏微波消融治疗。分析微波消融治疗前后MRI测量的脾脏体积、血小板计数、白细胞计数、红细胞计数变化及消融后并发症(包括发热、出血、疼痛、肾功能衰竭、血栓形成等)。结果:MRI测量24例患者脾脏体积消融前为692.4(504.7,1 023.7)cm^(3),微波消融60 d后减少至225.0(186.4,285.6)cm^(3),差异有统计学意义( Z=-3.23, P=0.001)。24例患者微波消融前后红细胞计数无显著变化,白细胞计数消融前为4.3(3.2,5.3)×10^(9)/L,微波消融3 d后白细胞计数升高至11.0(8.6,15.8)×10^(9)/L,与消融前比较,差异有统计学意义( Z=-4.70, P<0.001),消融90 d后恢复至5.0(3.3,6.1)×10^(9)/L,与消融前比较,差异无统计学意义( Z=-0.34, P=0.732)。24例患者微波消融前血小板计数为47.0(39.0,67.0)×10^(9)/L,微波消融7 d后血小板计数升高至155.0(120.3,214.3)×10^(9)/L,消融90 d后为77.0(63.0,125.0)×10^(9)/L,与消融前比较,差异均有统计学意义( Z=-5.29、-2.51, P<0.001、 P=0.012)。24例患者消融术后均未发生明显出血,且无死亡发生,仅1例(4.2%)发生肾功能衰竭,1例(4.2%)脾静脉血栓形成,4例(16.7%)出现不同程度疼痛,5例(20.8%)出现发热,未超过38.5℃。 结论:脾动脉球囊阻断联合脾脏微波消融治疗肝癌合并肝硬化脾功能亢进患者缩小了脾脏体积,提升血小板计数,并且并发症安全可控。ObjectiveTo analyze the efficacy and safety of splenic artery occlusion combined with microwave ablation(MWA)in the treatment of hepatocellular carcinoma(HCC)complicated with liver cirrhosis and hypersplenism.MethodsClinical data of 24 patients with HCC complicated with cirrhosis and secondary hypersplenism admitted to Airport Hospital of Tianjin Cancer Hospital from August 2023 to May 2024 were retrospectively analyzed,including 13 males and 11 females,aged(57.4±7.8)years.All patients were treated with splenic artery occlusion combined with MWA of spleen.Spleen volume measured by MRI before and after MWA,blood routine changes and postoperative complications(fever,bleeding,pain,renal failure and thrombosis)were analyzed.ResultsThe splenic volume of 24 patients measured by MRI before MWA was 692.4(504.7,1023.7)cm^(3),and decreased to 225.0(186.4,285.6)cm^(3) after treatment for 60 days(Z=-3.23,P=0.001).The red blood cell counts were comparable before and after microwave ablation.The white blood cell count before MWA was 4.3(3.2,5.3)×10^(9)/L,which increased to 11.0(8.6,15.8)×10^(9)/L three days after treatment,and to 5.0(3.3,6.1)×10^(9)/L 90 days after treatment(Z=-4.70,-0.34,P<0.001,P=0.732).The platelet count of the patients was 47.0(39.0,67.0)×10^(9)/L before MWA,which increased to 155.0(120.3,214.3)×10^(9)/L seven days after Treatment,and to 77.0(63.0,125.0)×10^(9)/L 90 days after treatment(Z=-5.29,-2.51,P<0.001,P=0.012).None of the patients had obvious bleeding and no death occured.One patient(4.2%)developed renal failure,one patient(4.2%)had splenic venous thrombosis,4 patients(16.7%)had pain of different degrees,and 5 patients(20.8%)had low fever.ConclusionSplenic artery occlusion combined with MWA in the treatment of HCC complicated with liver cirrhosis and hypersplenism can significantly reduce spleen volume and increase platelet level with acceptable complications.

关 键 词：脾功能亢进 血小板减少 微波消融 脾动脉阻断 

分 类 号：R73[医药卫生—肿瘤]