Clinical Research Of Radiofrequency Ablation For Hypersplenism

Objective: This study attempted to treat hypersplenism with RFA technique, as a new minimally invasive procedure, with using RFA in patients with cirrhotic hypersplenism, to investigate the security and effectiveness of RFA in treatment of hypersplenism due to portal hypertension, to study the changes of portal hemodynamics and the bone marrow hematopoietic cells after RFA,to study the measure to calculate the spleen residual function, to investigate the relationship between the spleen ablation volume and the clinical effects ,and to provide scientific data and clinical evidence for future clinical performance.Methods: 28 patients of the disease were treated with RFA.in manners of systemic anaesthesia, through skin or in the operation or under the celoscope. On 1,3,7,14,30,60,180d after RFA, the WBC,RBC,Hb and PLT of peripheral blood were detected with automatic hemocyte analysor; the bone marrow nucleated cells were counted and classified with optical microscope;The platelet antibody PAIgG were determined through ELISA.The volume and the low density part of spleen after RFA were determined by enhanced CT .The portal hemodynamics were measured with Doppler ultrasonography.The radionuclide counting were measured with spleen imaging.Results: After RFA 1 case developed hematoma under the envelope of spleen, 5 patients had high fever ,5patients appeared hydrothorax in the left thorax.others did not have any significant complications . the items detected changed as follows: The WBC presented a significant elevated tendency. 1d after RFA appeared a significant difference between pre-operation groups and the WBC reached the highest level 7d after RFA (p<0.01). then dropped a little ,but sustained a higher level than the pre-operation during 180d after RFA;The PLT presented a significant elevated tendency. 1d after RFA appeared a significant difference between pre-operation groups and the PLT reached the highest level 30d after RFA (p<0.01);The platelet antibody PAIgG had a general descendant tendency and there was a significant positive-correlation between the elevated tendency of PLT and the descendant tendency of platelet antibody after RFA;The diameter of portal and spleen vein did not had significant changes .but the blood volume reduced; The bone marrow nucleated cells did not had significant changes after RFA.The average percentage of low density part of spleen after 7d RFA was 38.20±17.36%, after 30d RFA was 21.98±10.52%; The radionuclide counting was reduced 27.63±10.18% after RFA.Conclusion: It is safe and feasibile to perform radiofrequency ablation for patients with hypersplenism due to portal hypertension and has excellent curative effect in the near future. it could lower portal vein flow,reduce the pressure of the portal vein and increase hepatic artery flow. It is the major reason that the damaged blood cells and the blood cell antibodies are reduced that cause the blood cells rise after RFA.Spleen imaging is an accurate measurement to evaluate the residual function after RFA.That the volume of the spleen is ablated 50- 60% has the better effect.