TACE联合PSE治疗伴有肝硬化脾功能亢进原发性肝癌.doc

TACE联合PSE治疗伴有肝硬化脾功能亢进原发性肝癌[摘要] 目的 探讨TACE联合PSE在伴有肝硬化脾功能亢进的原发性肝癌患者介入性治疗上的临床应用价值。方法 58例原发性肝癌伴脾功能亢进的患者均采用TACE和PSE治疗。介入治疗后分别定期复查患者的外周血常规，通过肝脏CT上碘油的沉积范围来评价TACE及PSE术后的疗效。结果 所有肿瘤的体积均变小。所有患者的AFP值术后均有不同程度的下降，其中40例患者（69%）的AFP降到100μg/L之内。所有患者在CT上可见脾脏内大小不等的低密度梗死区，范围为40%～80%。本组病例术后无明显严重的并发症发生。结论 TACE联合PSE在伴有脾功亢进的原发性肝癌患者的治疗上具有较大的临床价值。 [关键词] 原发性肝癌； 脾功能亢进； 经动脉化疗栓塞术； 部分脾动脉栓塞术 [中图分类号] R735.7 [文献标识码] A [文章编号] 1673-9701（2009）13-11-03 Application of TACE and PSE in Treatment of Primary Hepatic Carcinoma with Splenofunction Accentuation SUN Zhichang SUN Dewen The Second People’s Hospital in Panjin City，Liaoning 124000 [Abstract] ObjectiveTo explore the clinical value of interventional therapy in primary liver carcinoma patients with splenofunction accentuation by both Transarterial Chemoembolization（TACE） and PSE. MethodsThere are 58 primary liver carcinoma patients with splenofunction accentuation，who had been treated by both TACE and PSE. After the interventional therapies，the blood cells account and the depositive field of iodized oil in CT of all patients had been measured to appraise the curative effects of TACE PSE. ResultsThe volumes of all tumors had reduced after the interventional therapies，with the AFP values going down. There were 40 patients whose AFP values reached to blow 100μg/L. There was a big or small low-density lineal infarctus in all patients with depositive fields from 40% to 80% in CT. There wasn’tserious complications in all the patients. ConclusionIt is useful oftreating primary liver carcinoma patients with splenofunction accentuation by both TACE and PSE. [Key Words]Primary liver carcinoma； Splenofunction accentuation； Transarterial chemoembolization（TACE）； Partial spleen embolization（PSE） 目前，经肝动脉化疗栓塞术（TACE）已成为中晚期肝癌的首选治疗[1]，但是，鉴于70%～90%的原发性肝癌患者伴有肝硬化及脾功能亢进，因此在临床治疗中常发生因肝硬化脾功能亢进引起外周血常规数值的降低（包括白细胞、血小板），进而影响TACE手术实施的情况[2]。为了克服肝硬化所致脾功亢进对TACE手术的影响，笔者自2003年6月起对58例原发性肝癌合并肝硬化脾功能亢进的患者同时进行了“TACE+部分脾动脉栓塞术（PSE）”的治疗，取得了较好的临床疗效，现报道如下。 1 材料与方法 1.1