Clinical study on thirty-eight cases of percutaneous microwave ablation in the treatment of hypersplenism / 中华消化杂志

ABSTRACT

Objective To investigate the efficacy and safety of percutaneous microwave ablation in the treatment of hypersplenism.Methods From March 2007 to May 2011,38 patients with hepatitis B virus caused liver cirrhosis and complicated with hypersplenism received percutaneous microwave ablation treatment for several times.Before percutaneous microwave ablation treatment,the volume of spleen was calculated according to 3D computed tomography (CT) scan.Ultrasound,blood routine,urine routine,liver function test,kidney function test,serum amylase and lipase were also tested.For the first time,1/3 volume of spleen was ablated.If no complication were observed in one week after ablation,then another 1/3 volume of spleen was ablated.Blood routine and liver function test were checked on the 1st,3rd and 5th day after microwave ablation.Blood routine,liver function test and ultrasound were examined on 7th and 14th day after microwave ablation.On the 30th day CT examination was conducted.Ultrasound,blood routine,urine routine,liver function test,kidney function test,serum amylase and lipase were detected at one month,three month and every three month after microwave ablation.The follow up duration was over two years.The t-test was performed for clinical data comparison.Results The mean ratio of ablated spleen was (47 ±5)％ (range 41％ to 57％).Preoperative white blood cell count was (2.46±0.78)× 109/L,which gradually increased after operation and peaked on the 3rd day after operation ((5.34 ± 2.10) × 109/L).Then gradually decreased,which was (3.16 ± 1.02) × 109/L at 24 month and the difference was statistically significant compared with that of preoperation (t=-3.349,P＜0.01).Preoperative platelet count was (46.58 ± 17.30) × 109/L,which gradually decreased after operation and was lowest on the 3rd day after operation.Then gradually increased,which peaked at 30 days after operation ((101.79 ± 25.80) × 109/L) and then gradually decreased,which was (61.97 ± 15.09) × 109/L at 24 month and the difference was statistically significant compared with that of preoperation (t＝-4.135,P＜0.01).The inner diameter of portal vein was (14.66±0.88) mm preoperation,which was (13.22±0.64) mm at three month after operation and the difference was statistically significant compared with that of preoperation (t=8.145,P＜0.01).It was (14.64±0.81) mm at six month after operation and the difference was not statistically significant compared with that of preoperation (P＞ 0.05).The major adverse effects were fever,left upper abdominal pain,left shoulder pain,pleural effusion,intraperitoneal hemorrhage and temporary hemoglobinuria which all recovered after symptomatic treatment.No severe complication such as uncontrollable bleeding,splenic abscess,spleen rupture and the surrounding organ injury and treatment related death were observed.Conclusion Percutaneous microwave ablation for several times could safely destroy suitable volume of spleen,increase platelet and white blood cell count,improve portal hypertension and with rare complications,which might be a minimally invasive techniques with clinical application value in the treatment of the hypersplenism.