原发性肝癌合并脾功能亢进低剂量姑息性放射治疗的临床研究

Clinical Study of Low Dose Palliative Radiotherapy for Hepatocellular Carcinoma Complicated with Hypersplenism

摘要: 目的：评价原发性肝癌合并脾功能亢进低剂量姑息性放射治疗的疗效及其临床意义。方法：对我院符合诊断标准的28例原发性肝癌伴脾功能亢进患者三维适形放射治疗，分割剂量2 Gy/次，5次/周，总剂量10~25 Gy，治疗4周中监测白细胞，红细胞，血小板，以及门静脉主干，脾静脉和脾指数等各项指标。结果：28例患者在治疗刚开始1周白细胞、血小板有轻度下降，随后白细胞及血小板开始恢复。放疗前后白细胞、血小板数比较，差异有统计学意义(p < 0.05)。治疗后1周复查白细胞及血小板均有不同程度的下降，治疗第3周白细胞、血小板明显上升，治疗后12周血小板开始有下降趋势。对照红细胞及血红蛋白放疗前后比较，差异无统计学意义(p > 0.05)。治疗后门静脉主干，脾静脉，脾指数均有不同程度缩小，差异有统计学意义(p < 0.05)。结论：原发性肝癌导致的脾功能亢进予低剂量姑息性放射治疗可以使脾脏体积和血供减小，白细胞、血小板上升，有效的缓解患者症状。此方法是一种安全、有效的治疗方式，值得临床推广应用。

Abstract: Object: To evaluate the efficacy and clinical significance of primary hepatocellular carcinoma with low dose palliative radiotherapy. Methods: A total of 28 cases of primary hepatocellular carcinoma with hypersplenism were performed by three-dimensional conformal radiotherapy in our hospital, with the dividing dose of 2 Gy/time, 5 times/week, and the total dose were 10 - 25 Gy. After four weeks of treatment, white blood cells, red blood cells, platelets, and the main body of the portal vein, the splenic vein and the spleen index were monitored. Results: 28 patients had mild decrease in white blood cells and platelets in the first week of treatment, then the white blood cells and platelets begin to recover. The difference of white blood cells and platelet count was statistically significant before and after radiotherapy (p < 0.05). Both white blood cells and platelets were reduced by 1 week after treatment; white blood cells and platelets increased significantly in the third week; platelets began to decline after 12 weeks of treatment. Compared to the erythrocyte and haemoglobin radiotherapy, the difference was not statistically significant (p > 0.05). After treatment, the main vein of the portal vein, the splenic vein, and the spleen index were all reduced to a different degree, and the difference was statistically significant (p < 0.05). Conclusion: Hypersplenism caused by primary liver cancer is associated with low dose palliative radiotherapy which can reduce the volume and blood supply of the spleen, leads to the leucocyte and platelet increased, and alleviate the symptoms of the patients effectively. This method is a safe and effective treatment and is worthy of clinical application.