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目的比较经皮多次微波消融与单次微波消融治疗肝硬化所致脾功能亢进症的疗效及并发症发生情况。方法 2011年3月至2014年11月对本院39例(19名患者1次微波消融,20名患者行多次微波治疗)肝硬化脾功能亢进症患者实施超声引导下经皮穿刺脾脏微波消融治疗,对比总结两组患者的临床疗效及并发症发生情况。结果 39例患者手术均成功,无术中术后大出血、胃肠道穿孔以及肝、肾、胰腺损伤等并发症。平均手术时间为(2.8±1.5)h,平均消融时间为(1.7±0.9)h,单次消融组与多次消融组术中术后VAS评分无显著差异。两组患者术后6个月白细胞指标具有显著差异(3.5±0.7 vs 4.1±0.9),两组术后血小板计数也存在显著差异(61.7±12.9 vs 68.1±15.8)。肝功能指标的对比中,单次消融手术相比多次消融手术ALT明显下降(43.9±16.2 vs 50.1±20.6)。结论多次经皮穿刺微波消融治疗脾功能亢进症并不增加相应手术并发症,近期疗效也相对较好,但远期治疗效果有待进一步观察以及大量临床前瞻性研究证实。
Objective To compare the curative effect and complication of hepatic cirrhosis-induced hypersplenism treated by percutaneous multiple microwave ablation and single microwave ablation. Methods From March 2011 to November 2014, 39 patients (19 patients with 1 microwave ablation and 20 patients with multiple microwaves) were treated with ultrasound-guided microwave ablation of spleen in patients with liver cirrhosis and hypersplenism Treatment, compared the two groups of patients to summarize the clinical efficacy and complications. Results All the 39 patients were successful in operation. There were no postoperative hemorrhage, perforation of the gastrointestinal tract and complications such as liver, kidney and pancreas injury. The average operation time was (2.8 ± 1.5) h, the average ablation time was (1.7 ± 0.9) h, there was no significant difference in VAS score between single ablation group and multiple ablation group. There was a significant difference in the leukocyte index between the two groups (3.5 ± 0.7 vs 4.1 ± 0.9) 6 months after operation. The postoperative platelet count was also significantly different between the two groups (61.7 ± 12.9 vs 68.1 ± 15.8). ALT was significantly lower in single ablation compared with multiple ablations (43.9 ± 16.2 vs 50.1 ± 20.6) in the comparison of liver function parameters. Conclusion Multiple percutaneous microwave ablation of hypersplenism does not increase the corresponding surgical complications, the recent efficacy is relatively good, but the long-term treatment effect needs further observation and a large number of clinical prospective studies confirm.