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目的 评价部分脾栓塞术治疗肝癌合并肝硬化脾功能亢进 (脾亢 )的价值。方法 将 5 2例肝癌合并脾亢的患者分成部分脾栓塞 (partialsplenicembolization ,PSE)组和部分脾栓塞 (PSE) +肝动脉化疗栓塞 (transcatheterhepaticarterialchemoem bolization ,THAE)组。术前、术后第 2、3、5、7天及 3个月观察血像变化。结果 43例患者血像恢复正常 ,47例栓塞体积大于5 0 .0 %。部分脾栓塞后患者的血像从第 2天开始升高 ,白细胞总数在第 3～ 5天达到峰值 ,从 (2 .5 9± 0 .5 8)× 10 9/L升至 (11.17±5 .45 )× 10 9/L ,中性粒细胞从 (1.48± 0 .5 2 )× 10 9/L升至 (8.74± 4.2 3)× 10 9/L ,5～ 9天血小板达到峰值从 (5 2 .14± 2 0 .86 )× 10 9/L升至 (12 3 .41± 2 6 .47)× 10 9/L。 3个月后稳定值白细胞总数为 (4.6 3± 3 .0 2 )× 10 9/L ,中性粒细胞为 (3 .44± 2 .2 7)× 10 9/L ,血小板为 (86 .18± 2 0 .45 )× 10 9/L。白细胞升高以中性粒细胞为主。结论 部分脾栓塞能替代脾切除改善脾亢 ,肝动脉化疗栓塞结合部分脾栓塞治疗肝癌合并肝硬化脾亢的方法安全有效。
Objective To evaluate the value of partial splenic embolization in the treatment of liver cancer complicated with liver cirrhosis and hypersplenism (hypersplenism). Methods Fifty-two patients with hepatocellular carcinoma complicated with hypersplenism were divided into partial splenic embolization (PSE) group and partial splenic embolization (PSE) + transcatheter hepatic arterial chemoembolization (THAE) group. Preoperative, postoperative 2, 3, 5, 7 and 3 months observed changes in blood. Results The blood images of 43 patients returned to normal, and the volume of embolism in 47 patients was more than 50.0%. After partial splenic embolization, the blood picture of patients increased from the second day, and the total number of white blood cells reached the peak on the 3rd to 5th days, rising from (2.59 ± 0.58) × 10 9 / L to (11.17 ± 5) .45) × 10 9 / L, neutrophils increased from (1.48 ± 0.52) × 10 9 / L to (8.74 ± 4.2 3) × 10 9 / L, 5 2 .14 ± 2 0 .86) × 10 9 / L to (12 3 .41 ± 2 6 .47) × 10 9 / L. After 3 months, the total number of stable white blood cells was (4.6 3 ± 3 .0 2) × 10 9 / L, neutrophils was (3.44 ± 2.27) × 10 9 / L and platelets were (86. 18 ± 20.45) × 10 9 / L. Leukocytosis to neutrophil-based. Conclusions Partial splenic embolization can replace splenectomy to improve hypersplenism. The combination of transcatheter arterial chemoembolization and partial splenic embolization in the treatment of liver cancer with cirrhosis and hypersplenism is safe and effective.