脾功能亢进微波消融治疗的临床研究

摘要

Objective To investigate the best method of the treatment for hypersplenism by ultrasound-guided microwave ablation.Methods 54 patients with the liver cirrhosis and portal hypertension disease were treated by color ultrasound-guided percutaneous latticed puncture microwave ablation,then white blood cell (WBC),red blood cell (RBC),platelet (PLT),and diameter (D),peak blood flow velocity (Vmax),mean blood flow velocity (Vmean) of splenic vein,splenic venous flows (Q) were detected before and after operation in the 7 th,30 th,90 th,180 th and 360 th day.Results Seven days after microwave ablation,both WBC and PLT were significantly higher than the levels before the operation (P ＜ 0.05),and Vmax,Vmean,Q of spenic arteriovenous were significantly higher than the levels before the operation (P ＜ 0.05),in addition,fiber cord could prevent compensatory hypertrophy of spleen after latticed microwave ablation.Conclusion Using percutaneous latticed puncture microwave ablation could treat the hypersplenism effectively,decrease portal pressure,improve low blood celluar caused by hypersplenism.And after combined with endoscopic variceal ligation it can prevent upper gastrointestinal bleeding.%目的 探讨微波消融治疗脾功能亢进的最佳方法.方法 54名肝炎后肝硬化门脉高压脾功能亢进患者在彩超引导下经皮网格状脾穿刺微波消融术,分别在术前及术后7、30、90、180、360天检测外周血WBC、RBC、PLT及脾动静脉内径(D)、最大血流速度(Vmax)、平均血流速度(Vmean)、计算脾血流量(Q).结果 54名患者WBC、PLT术后7天较术前明显升高(P＜0.05),脾脏动静脉Vmax、Vmean、Q降低(P＜0.05),并且网格状消融后产生的纤维条索能预防消融后的脾脏代偿性增生.结论 采用网格状经皮脾穿刺消融术可有效治疗脾功能亢进,降低门静脉压力,改善脾亢引起的血细胞过低,结合胃镜下食道静脉套扎术可预防上消化道出血发生.