中华消化杂志
中華消化雜誌
중화소화잡지
Chinese Journal of Digestion
2014年
8期
535-538
,共4页
微波消融%脾功能亢进症%疗效
微波消融%脾功能亢進癥%療效
미파소융%비공능항진증%료효
Microwave ablation%Hypersplenism%Efficacy
目的 探讨经皮微波消融脾脏治疗脾功能亢进的临床效果和安全性.方法 选取2007年3月至2011年5月慢性乙型肝炎肝硬化继发中重度脾功能亢进患者38例.行经皮分次微波消融治疗前,先经三维CT平扫计算脾脏体积,并行多普勒超声、血常规、尿常规、肝功能、肾功能、血清淀粉酶水平、血清脂肪酶水平检查.第1次操作的消融体积约为初始脾脏的1/3,1周后若无明显并发症,则再次消融1/3初始脾脏体积的脾脏组织.微波消融后第1、3、5天分别行血常规和肝功能检查.微波消融后第7和14天分别行血常规、肝功能、多普勒超声检查.微波消融后第30天行增强CT检查.微波消融后1和3个月,以及之后每3个月行血常规、肝功能、肾功能、血清淀粉酶水平和多普勒超声检查.随访时间＞2年.临床数据的比较采用t检验.结果 消融体积比例为41％～57％,平均为(47±5)％.术前白细胞平均计数为(2.46±0.78)×109/L,术后渐升,至术后第3天达峰值[(5.34±2.10)×109/L],之后渐下降,术后24个月时为(3.16±1.02)×109/L,与术前比较差异有统计学意义(t＝-3.349,P＜0.01).术前血小板计数为(46.58±17.30)×109/L,术后渐下降,至术后第3天达最低点,之后开始上升,于术后30 d内达峰值[(101.79±25.80)×109/L],之后渐下降,术后24个月时为(61.97±15.09)×109/L,与术前比较差异有统计学意义(t＝-4.135,P＜0.01).术前门静脉平均内径为(14.66±0.88) mm,术后3个月时为(13.22±0.64) mm,与术前比较差异有统计学意义(t=8.145,P＜0.01),术后6个月时为(14.64±0.81) mm,与术前比较差异无统计学意义(P＞0.05).主要不良反应为发热、左上腹痛、左肩痛、胸腔积液、腹腔出血、短时血红蛋白尿,对症治疗后均恢复.未发生无法控制的出血、脾脓肿、脾破裂、周围器官损伤等严重并发症或治疗相关的死亡.结论 经皮分次微波消融能安全有效地毁损适当体积的脾脏,提高血小板和白细胞计数,改善门静脉高压,且并发症少,是有临床应用价值的脾功能亢进微创治疗技术.
目的 探討經皮微波消融脾髒治療脾功能亢進的臨床效果和安全性.方法 選取2007年3月至2011年5月慢性乙型肝炎肝硬化繼髮中重度脾功能亢進患者38例.行經皮分次微波消融治療前,先經三維CT平掃計算脾髒體積,併行多普勒超聲、血常規、尿常規、肝功能、腎功能、血清澱粉酶水平、血清脂肪酶水平檢查.第1次操作的消融體積約為初始脾髒的1/3,1週後若無明顯併髮癥,則再次消融1/3初始脾髒體積的脾髒組織.微波消融後第1、3、5天分彆行血常規和肝功能檢查.微波消融後第7和14天分彆行血常規、肝功能、多普勒超聲檢查.微波消融後第30天行增彊CT檢查.微波消融後1和3箇月,以及之後每3箇月行血常規、肝功能、腎功能、血清澱粉酶水平和多普勒超聲檢查.隨訪時間＞2年.臨床數據的比較採用t檢驗.結果 消融體積比例為41％～57％,平均為(47±5)％.術前白細胞平均計數為(2.46±0.78)×109/L,術後漸升,至術後第3天達峰值[(5.34±2.10)×109/L],之後漸下降,術後24箇月時為(3.16±1.02)×109/L,與術前比較差異有統計學意義(t＝-3.349,P＜0.01).術前血小闆計數為(46.58±17.30)×109/L,術後漸下降,至術後第3天達最低點,之後開始上升,于術後30 d內達峰值[(101.79±25.80)×109/L],之後漸下降,術後24箇月時為(61.97±15.09)×109/L,與術前比較差異有統計學意義(t＝-4.135,P＜0.01).術前門靜脈平均內徑為(14.66±0.88) mm,術後3箇月時為(13.22±0.64) mm,與術前比較差異有統計學意義(t=8.145,P＜0.01),術後6箇月時為(14.64±0.81) mm,與術前比較差異無統計學意義(P＞0.05).主要不良反應為髮熱、左上腹痛、左肩痛、胸腔積液、腹腔齣血、短時血紅蛋白尿,對癥治療後均恢複.未髮生無法控製的齣血、脾膿腫、脾破裂、週圍器官損傷等嚴重併髮癥或治療相關的死亡.結論 經皮分次微波消融能安全有效地燬損適噹體積的脾髒,提高血小闆和白細胞計數,改善門靜脈高壓,且併髮癥少,是有臨床應用價值的脾功能亢進微創治療技術.
목적 탐토경피미파소융비장치료비공능항진적림상효과화안전성.방법 선취2007년3월지2011년5월만성을형간염간경화계발중중도비공능항진환자38례.행경피분차미파소융치료전,선경삼유CT평소계산비장체적,병행다보륵초성、혈상규、뇨상규、간공능、신공능、혈청정분매수평、혈청지방매수평검사.제1차조작적소융체적약위초시비장적1/3,1주후약무명현병발증,칙재차소융1/3초시비장체적적비장조직.미파소융후제1、3、5천분별행혈상규화간공능검사.미파소융후제7화14천분별행혈상규、간공능、다보륵초성검사.미파소융후제30천행증강CT검사.미파소융후1화3개월,이급지후매3개월행혈상규、간공능、신공능、혈청정분매수평화다보륵초성검사.수방시간＞2년.림상수거적비교채용t검험.결과 소융체적비례위41％～57％,평균위(47±5)％.술전백세포평균계수위(2.46±0.78)×109/L,술후점승,지술후제3천체봉치[(5.34±2.10)×109/L],지후점하강,술후24개월시위(3.16±1.02)×109/L,여술전비교차이유통계학의의(t＝-3.349,P＜0.01).술전혈소판계수위(46.58±17.30)×109/L,술후점하강,지술후제3천체최저점,지후개시상승,우술후30 d내체봉치[(101.79±25.80)×109/L],지후점하강,술후24개월시위(61.97±15.09)×109/L,여술전비교차이유통계학의의(t＝-4.135,P＜0.01).술전문정맥평균내경위(14.66±0.88) mm,술후3개월시위(13.22±0.64) mm,여술전비교차이유통계학의의(t=8.145,P＜0.01),술후6개월시위(14.64±0.81) mm,여술전비교차이무통계학의의(P＞0.05).주요불량반응위발열、좌상복통、좌견통、흉강적액、복강출혈、단시혈홍단백뇨,대증치료후균회복.미발생무법공제적출혈、비농종、비파렬、주위기관손상등엄중병발증혹치료상관적사망.결론 경피분차미파소융능안전유효지훼손괄당체적적비장,제고혈소판화백세포계수,개선문정맥고압,차병발증소,시유림상응용개치적비공능항진미창치료기술.
Objective To investigate the efficacy and safety of percutaneous microwave ablation in the treatment of hypersplenism.Methods From March 2007 to May 2011,38 patients with hepatitis B virus caused liver cirrhosis and complicated with hypersplenism received percutaneous microwave ablation treatment for several times.Before percutaneous microwave ablation treatment,the volume of spleen was calculated according to 3D computed tomography (CT) scan.Ultrasound,blood routine,urine routine,liver function test,kidney function test,serum amylase and lipase were also tested.For the first time,1/3 volume of spleen was ablated.If no complication were observed in one week after ablation,then another 1/3 volume of spleen was ablated.Blood routine and liver function test were checked on the 1st,3rd and 5th day after microwave ablation.Blood routine,liver function test and ultrasound were examined on 7th and 14th day after microwave ablation.On the 30th day CT examination was conducted.Ultrasound,blood routine,urine routine,liver function test,kidney function test,serum amylase and lipase were detected at one month,three month and every three month after microwave ablation.The follow up duration was over two years.The t-test was performed for clinical data comparison.Results The mean ratio of ablated spleen was (47 ±5)％ (range 41％ to 57％).Preoperative white blood cell count was (2.46±0.78)× 109/L,which gradually increased after operation and peaked on the 3rd day after operation ((5.34 ± 2.10) × 109/L).Then gradually decreased,which was (3.16 ± 1.02) × 109/L at 24 month and the difference was statistically significant compared with that of preoperation (t=-3.349,P＜0.01).Preoperative platelet count was (46.58 ± 17.30) × 109/L,which gradually decreased after operation and was lowest on the 3rd day after operation.Then gradually increased,which peaked at 30 days after operation ((101.79 ± 25.80) × 109/L) and then gradually decreased,which was (61.97 ± 15.09) × 109/L at 24 month and the difference was statistically significant compared with that of preoperation (t＝-4.135,P＜0.01).The inner diameter of portal vein was (14.66±0.88) mm preoperation,which was (13.22±0.64) mm at three month after operation and the difference was statistically significant compared with that of preoperation (t=8.145,P＜0.01).It was (14.64±0.81) mm at six month after operation and the difference was not statistically significant compared with that of preoperation (P＞ 0.05).The major adverse effects were fever,left upper abdominal pain,left shoulder pain,pleural effusion,intraperitoneal hemorrhage and temporary hemoglobinuria which all recovered after symptomatic treatment.No severe complication such as uncontrollable bleeding,splenic abscess,spleen rupture and the surrounding organ injury and treatment related death were observed.Conclusion Percutaneous microwave ablation for several times could safely destroy suitable volume of spleen,increase platelet and white blood cell count,improve portal hypertension and with rare complications,which might be a minimally invasive techniques with clinical application value in the treatment of the hypersplenism.
