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目的 探讨射频消融 (RFA)治疗门静脉高压性脾大、脾功能亢进症的安全性及近期疗效。方法 在全麻、超声引导下经皮、开腹术中及腹腔镜下对 12例肝炎后肝硬化门静脉高压性脾大、脾功能亢进症患者进行RFA治疗。术前血细胞计数示 :白细胞为 ( 2 0± 0 7)× 10 9/L ,血小板 ( 2 5±10 )× 10 9/L ,红细胞 ( 3 0 8± 0 5 6 )× 10 9/L。将RFA针经皮、开腹术中及腹腔镜下在超声引导下经脾脏脏面插入脾脏中上部 ,RFA平均时间为 ( 36 4± 5 4 )s。术后进行血常规、CT复查评估 3个月内治疗效果。结果 治疗后合并脾包膜下血肿及皮肤烧伤各 1例 ,6例患者术后出现中少量左侧胸腔积液 ,2例行穿刺抽液 ,余无自觉症状。RFA后 10d左右增强CT测定脾脏体积和RFA病灶体积 ,RFA毁损范围占脾脏总体积的比率为 2 3 3%～ 88 9% ,平均 ( 4 9 1± 2 0 3) %。术后 14d白细胞 ( 5 5±0 9)× 10 9/L ,血小板 ( 12 4± 2 1)× 10 9/L。RFA术后 33d ,白细胞 ( 5 4± 1 1)× 10 9/L ,血小板 ( 2 0 5±34)× 10 9/L ;与术前相比 ,血小板和白细胞显著升高 (P <0 0 1)。结论 RFA治疗肝炎后肝硬化门静脉高压性脾大、脾功能亢进症具有安全、近期疗效显著的优点。
Objective To investigate the safety and short-term efficacy of radiofrequency ablation (RFA) in the treatment of portal hypertensive splenomegaly and hypersplenism. Methods RFA was performed in 12 patients with portal hypertensive splenomegaly and hypersplenism due to hepatitis with percutaneous, laparotomy and laparoscopy under general anesthesia and ultrasound guidance. Preoperative blood count showed: white blood cells (20 ± 0 7) × 10 9 / L, platelets (25 ± 10) × 10 9 / L, red blood cells (3 0 8 ± 0 5 6) × 10 9 / L. The RFA was percutaneously, laparotomically and laparoscopically inserted into the upper part of the spleen through the visceral surface of the spleen under ultrasound guidance. The average RFA time was (36 4 ± 5 4) s. Postoperative blood, CT review to assess the effect of treatment within 3 months. Results After the treatment of splenic subcapsular hematoma and skin burns in 1 case, 6 patients after operation in a small amount of left pleural effusion, 2 cases of puncture fluid, I without symptoms. Splenomegaly and RFA lesion volumes were measured by enhanced CT at 10 days after RFA. The range of RFA lesions was 23.3% ~ 88.9%, with an average of (491 ± 20%). The number of white blood cells (5 5 ± 0 9) × 10 9 / L and platelets (12 4 ± 2 1) × 10 9 / L at 14 days after operation. The number of white blood cells (5 4 ± 1 1) × 10 9 / L and the number of platelets (2 0 5 ± 34) × 10 9 / L after RFA were significantly higher than those preoperatively 1). Conclusion RFA treatment of cirrhosis of liver cirrhosis portal hypertensive splenomegaly, hypersplenism has the advantages of safe, short-term curative effect.