部分脾动脉栓塞与经皮射频消融治疗肝硬化门脉高压性脾亢的临床对比研究

发布时间：2018-06-07 01:29

本文选题：肝硬化 + 脾功能亢进　；参考：《昆明医科大学》2015年硕士论文

【摘要】：背景脾功能亢进(脾亢)是肝硬化门脉高压症患者最常见的并发症之一,而脾脏是一个有多种重要功能的器官,传统的脾切除术存在着较大的局限性和并发症。已逐渐被部分脾动脉栓塞术(Partial splenic artery embolization, PSE)所取代,但PSE也仍然存在着栓塞后综合征、脾脓肿等不良反应及并发症。随着介入放射学的发展,近些年,采用射频消融术(Radiofrequency ablation, RFA)治疗脾亢的报道日益增多,为脾亢治疗开辟了新的途径,RFA可引起组织的凝固性坏死,而非液化性坏死,通常认为RFA术后脾脓肿、感染的发生率较低,并发症较少,安全性较高,但同时也有对RFA治疗脾亢持怀疑态度的,他们认为RFA具有治疗范围难以精确的本身技术缺陷,远期疗效不明,且术中不良反应多,容易导致腹腔大出血的风险。究竟两种方法在治疗肝硬化门脉高压性脾亢中应用的各自疗效及优势如何值得进一步的探讨。目的对PSE与RFA两种方法在治疗肝硬化门脉高压性脾亢中的疗效、不良反应及并发症进行对比分析,探索一种疗效确切、安全性高、并发症少的治疗方案,从而为患者选择合适的治疗方案提供依据。资料与方法经医院伦理委员会批准,对我院连续收治的2012年08月至2014年04月间符合入组标准的60例肝硬化门静脉高压脾功能亢进患者在术前签署知情同意书后进行随机分组,将患者分为部分脾动脉栓塞组(对照组)和射频消融组(研究组)。分别于术前、术后1周、2周、1个月、3个月、6个月、12个月行血常规、腹部CT检查,记录手术时间、术中、术后不良反应,住院时间及住院费用情况,对各项指标进行统计分析,对组间差异进行对比,分析、探讨相关影响因素。结果(1)PSE组平均手术时间为(1.2±0.5)h, RFA组平均手术时间为(3.8±1.1) h, RFA组手术时间明显高于PSE组(P0.05)。(2)PSE组术中VAS疼痛评分平均为(1.2±0.9)分,RFA组术中VAS疼痛评分平均为(5.3±1.41)分,RFA组术中疼痛评分明显高于PSE组(P0.05)。(3)PSE组术后不良反应评价指标较RFA组显著增高(P0.05)。(4)PSE组脾脏坏死比例为40%-80%,平均为(62.2±10.1)%,术后1周、2周、1个月、3个月、6个月、12个月外周血细胞计数分别较术前显著改善,差异有统计学意义(P0.05),其中2例脾脏坏死比例在50%以下的患者术后12个月外周血细胞计数降至术前水平；RFA组脾脏坏死比例为20%-60%,平均为(30.7±10.2)%,术后1周、2周、1个月、3个月外周血细胞计数分别分别较术前改善,差异有统计学意义(P0.05),术后6个月外周血细胞计数明显下降(P0.05),脾功能亢进复发,1年后外周血细胞计数降至术前水平,其中9例脾脏坏死比例在50%-60%的患者术后12个月外周血细胞计数仍维持在较高水平；两组中PSE组术后血小板及白细胞计数改善明显优于RFA组(P0.05)。(5)PSE组住院时间为15-100天,平均为(22.3±3.7)天,RFA组住院时间为10-30天,平均为(16.8±5.2),PSE组住院时间高于RFA组(P0.05)。(6)PSE组平均住院费用为26212.71±31093.12元,RFA组平均住院费用为27391.23±19375.67元,两组间统计学无差异。结论1、PSE与RFA两种方法对脾功能亢进者均疗效确切,两种方法术后疗效与脾脏坏死比例均呈正相关性。2、PSE与RFA两种方法术后不良反应及并发症与脾脏坏死比例均呈正相关性。PSE术中手术时间短,不良反应较轻,术中严格控制脾脏的栓塞比例,可显著减轻术后不良反应及并发症的发生率,RFA受制于器械、材料等原因,单针消融范围不足,术中为了扩大消融范围,从而导致患者手术时间增长、疼痛增加,不良反应加重.本研究认为现阶段我们倾向于优选PSE治疗方法。
[Abstract]:Hypersplenism (hypersplenism) is one of the most common complications in patients with cirrhosis of the portal hypertension, and the spleen is an organ with many important functions. Traditional splenectomy has great limitations and complications. It has been gradually replaced by Partial splenic artery embolization (PSE), but PSE also There still exist adverse reactions and complications of post embolic syndrome and splenic abscess. With the development of interventional radiology, the treatment of hypersplenism with Radiofrequency ablation (RFA) has increased in recent years, which has opened a new way for the treatment of hypersplenism. RFA can cause coagulation necrosis of tissue, not liquefied necrosis. It is believed that the incidence of splenic abscess after RFA is low, the complications are less and the safety is higher, but at the same time, it also has a skeptical attitude to the treatment of hypersplenism with RFA. They think that RFA has the difficulty of the precise technical defects in the treatment range, the long term effect is unknown, and the adverse reaction is easy to lead to the risk of massive hemorrhage in the abdominal cavity. Two kinds of methods are used. The efficacy and advantages of the method in the treatment of Hepatocirrhosis Portal Hypertensive hypersplenism are worthy of further discussion. Objective to compare the efficacy, adverse reactions and complications of the two methods of PSE and RFA in the treatment of hepatocirrhosis with hyperbaric hypersplenism, and to explore a therapeutic scheme with definite curative effect, high safety and less complications. According to the data and methods approved by the hospital ethics committee, 60 patients with cirrhosis of the portal hypertension and hypersplenism between 08 months and 04 months in our hospital from 2012 to 2014 were randomly divided into parts, and the patients were divided into parts. Splenic artery embolization group (control group) and radiofrequency ablation group (Study Group) were performed before operation, 1 weeks, 2 weeks, 1 months, 3 months, 6 months, 12 months of blood routine, abdominal CT examination, record the operation time, intraoperative, postoperative adverse reactions, hospitalization time and hospitalization expenses, the statistical analysis of the indexes, the differences of groups were compared and analyzed. Results (1) the average operation time of group PSE was (1.2 + 0.5) h, the average operation time of group RFA was (3.8 + 1.1) h, and the operation time of group RFA was significantly higher than that of group PSE (P0.05). (2) the average of VAS pain score in group PSE was (1.2 + 0.9), VAS pain score in RFA group was (5.3 + 1.41), and the pain score in RFA group was significantly higher than that in the group of RFA. Group PSE (P0.05). (3) the evaluation index of postoperative ADR in group PSE was significantly higher than that in group RFA (P0.05). (4) the proportion of spleen necrosis in group PSE was 40%-80%, average (62.2 + 10.1)%, 1 weeks, 2 weeks, 1 months, 3 months, 6 months, 12 months, 12 months, and 12 months, respectively, compared with before operation, and the difference was statistically significant (P0.05), of which 2 cases of splenic necrotic ratio were compared. The blood cell count of the patients under 50% months after operation was reduced to the preoperative level. The proportion of spleen necrosis in group RFA was 20%-60%, the average was (30.7 + 10.2)%, 1 weeks, 2 weeks, 1 months after operation, 1 months and 3 months, respectively. The difference was statistically significant (P0.05), and the number of peripheral blood cells decreased significantly in 6 months after the operation (P0 .05), the recurrence of hypersplenism, 1 years after the peripheral blood cell count decreased to the preoperative level, of which 9 cases of spleen necrosis in the patients with 50%-60% after 12 months of peripheral blood cell count still maintained at a high level; the two group of group PSE after the improvement of platelet and leukocyte count was significantly better than the RFA group (P0.05). (5) the PSE group was hospitalized for 15-100 days, The average time was (22.3 + 3.7) days, the time of hospitalization in group RFA was 10-30 days, the average was (16.8 + 5.2), and the time of hospitalization in group PSE was higher than that of group RFA (P0.05). (6) the average hospitalization cost in group PSE was 26212.71 + 31093.12 yuan, the average hospitalization cost in group RFA was 27391.23 + 19375.67 yuan, and there was no statistical difference between group two. Conclusion 1, PSE and RFA two methods were all treated with hypersplenism of spleen. The two methods had positive correlation with the proportion of spleen necrosis after the two methods, PSE and RFA had positive correlation with the two methods of postoperative adverse reactions and complications and the proportion of spleen necrosis. The operation time was shorter in.PSE operation, less adverse reaction, and the strict control of splenic embolization in the operation could significantly reduce the postoperative adverse reactions and complications. The incidence of RFA is controlled by instruments, materials, and other reasons. The single needle ablation range is insufficient. In order to expand the range of ablation, the operation time increases, the pain increases, and the adverse reaction is aggravated. This study suggests that we prefer to optimize the PSE treatment at this stage.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.63

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