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目的探讨三丙烯微球用于原发性肝癌合并脾功能亢进双介入治疗中的安全性和临床疗效。方法对30例原发性肝癌合并脾功能亢进的患者首先实施超选择插管对肝肿瘤供血动脉用碘化油和化疗药物的混合乳剂进行肿瘤微循环血管栓塞,再用直径500μm~700μm的三丙烯微球栓塞肿瘤供血动脉,透视下观察血流明显减慢或血管铸型时停止。再插管至脾动脉下极,用直径500μm~700μm的三丙烯微球进行超选择性脾动脉部分栓塞术,脾栓塞量60%~70%,术后第1、3、7、14、30天分别化验血常规,术后每月做肝脏增强CT或增强MRI检查随访,查AFP及肝功能,观察临床疗效。结果 30例患者,实验室检查:AFP下降,WBC术后24h,30例患者白细胞明显升高,其中有22例患者白细胞数值在正常范围;术后7天,29例WBC基本正常、只有1例略低于正常。PLT术后24h PLT有3例可见升高、27例未见明显改变;术后7天PLT显著升高20例,10例已经基本正常。术后30天CT复查肝肿瘤直径均不同程度的缩小,肿瘤内碘油完全沉积18例,沉积≥80%9例,沉积≤10%3例;脾实质梗死面积达70%11例、60%9例、50%10例。结论三丙烯微球用于原发性肝癌合并脾功能亢进双介入治疗中的临床疗效显著、性能安全可靠,在栓塞肝脏肿瘤组织的同时栓塞部分脾动脉,使门静脉高压降低,升高了白细胞、血小板数量,提高了患者的免疫力,降低了术后不良反应和严重并发症的发生。
Objective To investigate the safety and clinical efficacy of TPA microspheres for dual interventional therapy of primary hepatocellular carcinoma with hypersplenism. Methods Thirty patients with primary hepatocellular carcinoma complicated with hypersplenism were treated with superselective intubation for the microcirculation embolization of the hepatic tumor feeding artery with a mixed emulsion of iodized oil and chemotherapeutic drugs. Propylene microspheres embolization of tumor-feeding artery, blood flow was observed significantly slowed down or stop when the blood vessel mold. And then intubated to the lower extremity of the splenic artery, with a diameter of 500μm ~ 700μm of the super-selective splenic artery splenic artery embolization, splenic embolization volume of 60% to 70%, postoperative 1,3,7,14,30 Day, respectively, blood tests, postoperative monthly liver enhanced CT or enhanced MRI follow-up, check AFP and liver function, observe the clinical efficacy. Results In the 30 patients, the laboratory test showed that the AFP level decreased and the number of leukocytes in 30 patients increased significantly after WBC operation. The number of leukocytes in 22 patients was within the normal range. In the 7 days after operation, 29 WBCs were normal and only 1 patient Slightly below normal. PLT in 3 patients after PLT was elevated in 3 cases, 27 cases showed no significant change; 7 days after PLT was significantly increased in 20 cases, 10 cases have been basically normal. On the 30th day after operation, the diameter of hepatic tumor was reduced to varying degrees. Lipiodol was completely deposited in the tumor in 18 cases, the deposition was ≥80% in 9 cases, the deposition was less than 10% in 3 cases, the splenic real infarct size was 70% in 11 cases, 60% 9 cases, 50% 10 cases. Conclusion tripropylene microspheres for patients with liver cancer and hypersplenism bis clinical efficacy of interventional therapy significantly, reliable and safe in embolization liver tumor tissue at the same time part of splenic artery embolization, so reducing portal hypertension, elevated white blood cells, The number of platelets, improve the patient’s immunity, reduce the incidence of adverse reactions and serious complications.