目的 探讨脾部分栓塞术联合肝动脉化疗栓塞术在原发性肝癌伴脾功能亢进中的临床疗效及应用价值。方法 80 例原发性肝癌伴脾功能亢进患者，采用简单化随机法将所有患者分为对照组和实验组，每组 40 例。对照组患者实施肝动脉化疗栓塞术，实验组患者在对照组的基础上联合脾部分栓塞术。比较两组患者临床疗效、不良反应发生情况以及手术前后谷丙转氨酶(ALT)、总胆红素(TBIL)、白细胞计数(WBC)、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)。结果 实验组治疗总有效率 95。0%高于对照组的 77。5%，差异具有统计学意义(P<0。05)。实验组患者术前ALT为(55。57±8。56)U/L、TBIL为(24。25±3。12)μmol/L，术后 7 d ALT为(33。27±4。08)U/L、TBIL为(17。58±2。15)μmol/L;对照组患者术前ALT为(55。29±8。37)U/L、TBIL为(24。64±3。15)μmol/L，术后 7 d ALT为(49。68±6。65)U/L、TBIL为(22。12±2。86)μmol/L。与术前比较，术后 7 d两组患者ALT、TBIL水平均有所改善，且与对照组比较，实验组患者的ALT、TBIL水平改善效果更明显，均恢复至正常水平，差异具有统计学意义(P<0。05)。实验组患者术前WBC为(2。48±0。26)×109/L、PLT为(64。36±10。15)×109/L，术后 7 d WBC为(6。57±1。18)×109/L、PLT为(117。38±18。15)×109/L;对照组患者术前WBC为(2。39±0。18)×109/L、PLT为(64。51±10。22)×109/L，术后7 d WBC为(3。68±0。53)×109/L、PLT为(83。16±12。86)×109/L。与术前比较，术后 7 d两组患者的WBC、PLT水平均有所升高，且与对照组比较，实验组患者的WBC、PLT水平升高幅度更明显，均恢复至正常水平，差异具有统计学意义(P<0。05)。实验组患者术前PT为(19。26±2。24)s、APTT为(54。35±8。12)s，术后 7 d PT为(10。27±1。88)s、APTT为(31。63±4。15)s;对照组患者术前PT为(19。29±2。26)s、APTT为(54。26±8。10)s，术后 7 d PT为(16。56±2。05)s、APTT为(44。32±6。86)s。与术前比较，术后 7 d两组患者的PT、APTT均有所缩短，且与对照组比较，实验组患者PT、APTT缩短幅度更明显，均恢复至正常水平，差异具有统计学意义(P<0。05)。两组患者术中、术后均未出现严重不良反应，实验组不良反应发生率 7。5%低于对照组的 27。5%(P<0。05)。结论 肝动脉化疗栓塞术联合脾部分栓塞术能够有效改善原发性肝癌伴脾功能亢进患者的肝功能、血常规，促进患者的凝血功能恢复，且安全性良好，值得临床推广应用。
Clinical effect analysis of hepatic arterial chemoembolization combined with partial splenic embolization in the treatment of primary liver cancer with hypersplenism
Objective To explore the clinical efficacy and application value of hepatic arterial chemoembolization combined with partial splenic embolization in the treatment of primary liver cancer with hypersplenism.Methods A total of 80 patients with primary liver cancer and hypersplenism were divided into a control group and an experimental group,with 40 cases in each group.The control group underwent hepatic arterial chemoembolization,and the experimental group combined with partial splenic embolization on the basis of the control group.Both groups were compared in terms of clinical efficacy,occurrence of adverse reactions,and alanine aminotrasferase(ALT),total bilirubin(TBIL),white blood cell count(WBC),platelet count(PLT),prothrombin time(PT)and activated partial thromboplastin time(APTT)before and after surgery.Results The total effective rate of the experimental group was 95.0%,which was higher than 77.5%of the control group,and the difference was statistically significant(P<0.05).In the experimental group,ALT and TBIL were(55.57±8.56)U/L and(24.25±3.12)μmol/L before surgery,and(33.27±4.08)U/L and(17.58±2.15)μmol/L 7 d after surgery.In the control group,ALT and TBIL were(55.29±8.37)U/L and(24.64±3.15)μmol/L before surgery,and(49.68±6.65)U/L and(22.12±2.86)μmol/L 7 d after surgery.Compared with those before surgery,ALT and TBIL levels improved in both groups 7 d after surgery;compared with the control group,ALT and TBIL levels in the experimental group improved more significantly,and returned to normal level;the difference was statistically significant(P<0.05).In the experimental group,WBC and PLT were(2.48±0.26)×109/L and(64.36±10.15)×109/L before surgery,and(6.57±1.18)×109/L and(117.38±18.15)×109/L 7 d after surgery.In the control group,WBC and PLT were(2.39±0.18)×109/L and(64.51±10.22)×109/L before surgery,and(3.68±0.53)×109/L and(83.16±12.86)×109/L 7 d after surgery.Compared with before surgery,the levels of WBC and PLT increased in both groups 7 d after surgery;compared with the control group,the levels of WBC and PLT in the experimental group increased more significantly,and returned to normal level;the difference was statistically significant(P<0.05).In the experimental group,PT and APTT were(19.26±2.24)and(54.35±8.12)s before surgery,and(10.27±1.88)s and(31.63±4.15)s 7 d after surgery.In the control group,PT and APTT were(19.29±2.26)and(54.26±8.10)s before surgery,and(16.56±2.05)and(44.32±6.86)s 7 d after surgery.Compared with before surgery,PT and APTT in both groups were shortened 7 d after surgery;compared with the control group,PT and APTT in the experimental group were shortened more significantly,and both returned to normal level;the difference was statistically significant(P<0.05).No serious adverse reactions occurred in both groups,and the incidence of adverse reactions in the experimental group was 7.5%,which was lower than 27.5%in the control group(P<0.05).Conclusion Hepatic arterial chemoembolization combined with partial splenic embolization can effectively improve the liver function and blood routine of patients with primary liver cancer and hyperplenism,and promote the recovery of blood coagulation function in patients.It is safe and worthy of clinical application.
Primary liver cancer with hypersplenismHepatic arterial chemoembolizationPartial splenic embolizationClinical study
NETL
NSTL
万方数据
维普
