射频消融治疗肝细胞癌患者伴血小板减少症行部分性脾动脉栓塞的治疗益处。

Therapeutic benefits of partial splenic embolization for thrombocytopenia in hepatocellular carcinoma patients treated with radiofrequency ablation.

机构信息

Department of Gastroenterology, Internal Medicine, Kitasato University East Hospital, Sagamihara, Japan.

出版信息

Hepatol Res. 2009 Aug;39(8):772-8. doi: 10.1111/j.1872-034X.2009.00508.x. Epub 2009 Mar 25.

DOI:10.1111/j.1872-034X.2009.00508.x

PMID:19473438

Abstract

AIM

Partial splenic embolization (PSE) is a non-surgical procedure developed to treat hypersplenism. The purpose of this study is to evaluate therapeutic benefits of PSE with follow-up radiofrequency ablation (RFA) treatment in hepatocellular carcinoma (HCC) patients with thrombocytopenia.

METHODS

Between September 1999 and January 2007, a total of 20 patients with HCC who had a few lesions, each 3 cm or less in diameter, and liver function of Child-Pugh class A or B were enrolled into our study. The patients were diagnosed with marked thrombocytopenia (<50 x 10(3)/mm(3)), or mild thrombocytopenia (<80 x 10(3)/mm(3)) with decreased prothrombin activity. They were treated once or twice with PSE. RFA was given as a follow-up treatment 2 weeks after final PSE. The primary endpoint was a platelet-count increase and improvement of prothrombin activity, and the secondary endpoint was the initiation of RFA.

RESULTS

PSE was performed successfully in 19 patients (95%). Two weeks after final PSE, platelet counts increased significantly (38 +/- 14 x 10(3)/mm(3) vs. 97 +/- 43 x 10(3)/mm(3); P < 0.0001), and prothrombin activity improved significantly (59.3 +/- 19.8% vs. 65.2 +/- 17.9%; P < 0.0001). No patients had major complications during the PSE procedure. The secondary endpoint was achieved in 18 of 19 patients (94.7%). The mean overall survival was 2257 days (95% confidence interval; range, 1659-2855 days). The Kaplan-Meier cumulative survival rate was estimated to be 61.9% at 5 years.

CONCLUSIONS

PSE is a safe and effective treatment for thrombocytopenia and has adjuvant therapeutic benefits for the therapy of HCC.

摘要

目的

部分脾脏栓塞术（PSE）是一种非手术治疗方法，用于治疗脾功能亢进。本研究旨在评估 PSE 联合射频消融（RFA）治疗伴有血小板减少症的肝细胞癌（HCC）患者的治疗效果。

方法

1999 年 9 月至 2007 年 1 月，共纳入 20 例 HCC 患者，这些患者有少数直径 3cm 或以下的病灶，肝功能为 Child-Pugh 分级 A 或 B。这些患者被诊断为明显血小板减少症（<50×103/mm3），或伴有凝血酶原活动度降低的轻度血小板减少症（<80×103/mm3）。这些患者接受了 1 次或 2 次 PSE 治疗。PSE 治疗结束后 2 周行 RFA 治疗。主要终点是血小板计数增加和凝血酶原活性改善，次要终点是 RFA 的启动。

结果

19 例（95%）患者成功完成了 PSE。PSE 治疗结束后 2 周，血小板计数显著增加（38±14×103/mm3 比 97±43×103/mm3；P<0.0001），凝血酶原活性显著改善（59.3±19.8%比 65.2±17.9%；P<0.0001）。PSE 过程中无患者发生严重并发症。19 例患者中有 18 例（94.7%）达到了次要终点。总的中位生存时间为 2257 天（95%可信区间；范围，1659-2855 天）。Kaplan-Meier 累积生存率估计为 5 年时 61.9%。