The Study Of Radiofrequency Ablation For The Treatment Of Congestive Splenomagely And Hypersplenism

Objectives A porcine model of secondary hypersplenism was rapidly induced by embolization of splenic vein,which was treated by radiorequency ablation(RFA).The blood cell counts for peripheal venous blood were determined,the data of spleen size examined by radiological examinations and histopathological changes of spleen abserved regularly after hypersplenism were treated by RFA.We investigated the feasibility and efficacy of radiofrequency ablation for hypersplenism to provide laboratory data and clinical experience.To study the security and curative effect of RFA for hypersplenism due to portal hypertension in the near future.Methods there was two stages in the study:1 The animal experiment Ten healthy pigs were randomly divided into 3 groups: the first group(n=1) as normal;the second group,as control(embolization of splenic vein);the third group,as experimental(n=6)(embolization of splenic vein+ RFA).All animals were fasted for 12 hours before commencement of the subsequent procedures.Embolization of splenic vein was performed with animals of the control and experimental groups under general anesthesia.Ear vein blood was drawn for blood routine examination,spleen was scaned by CT.Under B ultrasound-guided,the right portal vein branch was percutaneously inserted into through liver parenchyma.In the DSA machine-guided,catheter was placed into the trunk of splenic vein and congestive splenomegaly was induced by embolization of splenic vein..The blood cell counts for peripheal venous blood were determined weekly and RFA in spleen treated secondary splenomagely and hypersplenism when the blood cell counts for peripheal venous blood changes conformed to the changes of chronic congestive spienomagely in the three weekends.The blood cell counts for peripheal venous blood were determined,the data of spleen size examined by CT each weekend after splenic RFA.meanwhile splenetomy was performed in 1 of the control group and 2 of the experimental group in order to observe the histopathological changes.Results The erythrocyte and platelet counts decreased in the first week and were significantly lowered in both groups at the end of the third week after splenic vein embolization plenic vein thrombosis.The erythrocyte and platelet counts of the experimental were significantly increased in the second week after RFA.CT findings revealed that the splenomegaly had remained over 6 weeks.Pathological examination revealed:the volume of splenic vein thrombosis increaesd significantly,and was sustainable to 6 weeks after embolization.Histopathological examination:Compared with normal spleen structure,congestive spleen enlarged,spleen sinus expanded and hemosiderin macrophages appeared after the two weeks In addition,4-6 weeks or so visible splenic sinus expansded,fibrous tissue within the spleen proliferated,splenic sinus were filled with micro-thrombosis,spleen trabecular and capsule were thickening.After RFA,the greater omentum and spleen RFA lesion surface adhered seriously,the segmental RFA lesions included hyperintense zone of coagulative necrosis and extensive peripheral hypointense infarcted zone.The microscope findings revealed that there was no obvious bleeding in spleen except the RFA needle track. The histopathological changes of splenic lesions induded local coagulative necrosis and peripheral thrombotic infarction.2 The clinical research Patients were in right lateral position,Ten patients fasted for 12 hours before commencement of the subsequent procedures.RFA was performed with the patients under local anesthesia.Ten patients who had portal hypertension and hypersplenism secondary to liver cirrhosis had B ultrasound--guided RFA of spleen percutaneously.The routine blood count was studied both before and after the procedure.Enhanced CT/MRI scanning was reexamined after the treatment and in the second weekends to determine the ablation volume of the spleen.Under Ultrasound-assisted,the needle electrode was inserted perpendicularly into splenic parenchyma 3～5cm in depth away from splenic capsule,hilum,and larger vessels.The electrode was retracted for 2.0 cm,and the above session was repeated.The needle track was cauterized upon the needle withdrawal.During the RFA procedure,dynamic ultrasound images of ablated spleen were recorded.After the RFA,1 case developed skin burn,1 patient appeared little fluid in the left thorax,but resolved within 2 weeks and required no additional control.The ablated volume of the spleen accounted for 25%～45%of the whole spleen,both of which were studied by MRI.Before the treatment,the counts of WBC was(3.3±0.43)×10⁹/L, the counts of RBC was(3.30±0.32)×10¹²/L,the one of PLT was(47±15)×10⁹/L;In the first weekend,the three of them were(4.56±0.34)×10⁹/L,(3.98±0.53)×10¹²/L,(75±6.5)×10⁹/L,which were significandy higher than that before the treatment(P＜0.05).In the two weekend,the three of them were(4.77±0.08)×10⁹/L,(4.23±0.58)×10¹²/L,(104±24)×10⁹/L,which was significandy higher than that before the treatment(P＜0.05).Conclusion 1,The method of splenic vein embolization to induce experimental secondary hypersplenism was a simple,effective,minal traumatic model for sugical or interventional therapy in hypersplenism.2,Radiofrequency ablation for hypersplenism due to portal hypertension of hepatitis hepatocirrhosis is safety and credibility and has excellent curative effect in the near future.3,It's not a long time for RFA for hypersplenism,many factors affects its therapeutic effects and further studies are necessary to clarify many underlying mechanisms.