双介入疗法治疗原发性肝癌伴脾功能亢进25例疗效观察
The liver and spleen interventional therapy for primary carcinoma of the liver with hyperspleenism
目的 探讨肝脾双介入疗法治疗原发性肝癌伴脾功能亢进(简称脾亢)的临床效果.方法 对25例原发性肝癌伴脾亢患者采用Seldinger方法,将5FRH导管插入肝固有动脉,灌注化疗药物总量的2/3;注入栓塞剂,或置换脾管,插入脾动脉,灌注化疗药物总量的1/3;超选至脾动脉下级分支注入明胶海绵.化疗应用联合方案:氟脲嘧啶750 mg、表阿霉素40 mg、丝裂霉素10 mg,10例患者加用顺铂40 mg.结果 25例中完全缓解1例,部分缓解8例,稳定6例,进展9例,死亡1例;治疗后的不良反应均为疼痛和发热,6例肝功能异常;术后4周内白细胞计数为(4.5±2.3)×10~9/L,血小板计数为(102.1±5.4)×10~9/L,比术前平均值:2.9×10~9/L、41.6×10~9/L明显增高;该组患者6个月生存率为100%,1年生存率为60%(15/25).结论 双介入疗法可以缓解原发性肝癌伴脾亢的症状,提高原发性肝癌的介入治疗效果.
更多Objective To study the value of the liver and spleen interventional therapy in primary carcinoma of the liver with hyperspleenism. Methods The treatment was given to 25 patients. Using the method of Seldinger,the 5FRH into artery hepatica propria to infuse 2/3 of the overall dose of chemotherapy medicine and embolism was inserted into the liver segment. Then 1/3 of it was infused into artery lienalis and gelatin sponge was infused into artery lienalis Rr. lienales. Combined regimens were used in chemotherapy: 5-Fu 750mg, EADM 40mg, MMC 10mmg,and 10 of the 25 added DDP 40mg. LUF and gelatin sponge were used for embolisation. Results Of the 25 patients,the WBC and PLT increased in 25 patients 4 weeks after the operation. The difference was significant. The survival rate at 6 and 12 months was 100% and 60% respectively,with 1 case of CR,8 cases of PR and 6 cases of SD. Patients had fever after the treatment but few with abnormal liver function tests. Conclusion Liver and spleen interventional therapy may relieve hyperspleenism and suggests that the treatment of primary carcinoma of the liver is effective.
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