Experimental And Clinical Studies On Radiofrequency Ablation For Hypersplenism Caused By Portal Hypertension

1. BackgroundSpleen is the body’s largest blood storage organ, mang reasons can cause spleen blood obstruction, can induce congestive splenomegaly. Our country has60-75%of cirrhotic patients with hypersplenism and portal hypertension, can occur splenomegaly, hypersplenism. Spleen is a vital organs which regulating immune, endocrine, secretion and so on. Splenomegaly caused by a variety of reasons, can make the proportion of blood volume increased, so that the normal or abnormal blood cells are destroyed in the filtration process. Hypersplenism anemia occurs when the body makes compensatory blood flow through the spleen, splenic vein is relatively overloaded, thereby causing increased portal pressure, and portal vein pressure increased further to splenomegaly, and thus a vicious circle.There are two main surgica treatment to liver cirrhosis portal hypertension splenomegaly:devascularization and shunt surgery, devascularization surgery is the most common type of surgery, including splenectomydevascularization plus cardiac peripheral vascular amputation. Splenectomy not only loss the immune function, further damage of liver cirrhosis and portal hypertension may caused by other conditions is more seriously; while retaining the spleen treatment is part resection, but the complication is much more, such as bleeding, fever, infection, thrombosis, etc.Radiofrequency ablation in the treatment of heart disease, gynecological diseases, solid tumors and other aspects are have very positive effect. There are few reports in the spleen preserving treatment, we intend to use RFA to study the spleen preserving treatment. We use the animal model study the RFA in treating splenomegaly, to provide the clinical experimental basis of RFA treatment; and then through the RFA treatment of portal hypertension with hypersplenism cases initial clinical observation of splenic RFA treatment of portal hypertension with hypersplenism clinical application.2. Materials and Methods2.1RFA treatment of hypersplenism experimental study2.1.1The animal and methodsThe experimental animal center of Zhengzhou University provides41health adult rabbits, and make the animal model, grouped (normal group, control group, experimental group) for radiofrequency ablation, make abdominal ultrasound examination a week before the experiment and post-operative to grasp changes in spleen size in rabbits, and weekly monitoring of changes in the value of peripheral blood cells and postoperative histopathological examination.2.1.2Statistical MethodsWe use the SPSS17.0statistical software for statistics, the data are expressed in X±S, the two groups of quantitative data were compared using t test, if it does not meet the conditions then use the t’test (a=0.05).2.2The preliminary clinical study of RFA in hypersplenism2.2.1Patients and methodsWe choose10cases of splenomegaly patients from The Fifth Affiliated Hospital of Zhengzhou University, treated with radiofrequency ablation after preliminary examination, and weekly monitoring of changes in the value of peripheral blood cells and CT or abdominal ultrasound examination. 2.2.2Statistical MethodsWe use the SPSS17.0statistical software for statistics, the data are expressed in X±S, the two groups of quantitative data were compared using t test, if it does not meet the conditions then use the t’test (a=0.05).3. Results3.1RFA treatment of hypersplenism experimental result3.1.1There was no postoperative complications (spleen ruptured, gastrointestinal perforation, pancreatic necrosis, abdominal bleeding, abdominal water, etc.) appeared, no animals died.3.1.2Histopathological changes:in the1st week, a large number of inflammatory cells and fibroblast cells can be found under the microscope, in the6th week, the spleen tissue is similar to normal one, the blood vessels of spleen is thicken, residual spleen shows interstitial fibrosis.3.1.3The number of RFA group patients’blood cells (erythrocytes, leukocytes, platelets) is back to normal group (P〈0.05).3.2Preliminary clinical RFA treatment of hypersplenism3.2.110operations were successful. Eight cases of patients with ascite disappeared in2weeks after supplementary protein and the diuretic nutrition support therapy; seven cases of patients with low-grade fever (37-37.8)°C,1patients with pleural effusions, the symptoms disappeared in3weeks without treatment, other patients have not splenic abscess, pneumothorax, stomach, intestinal perforation, pancreatic injury, postoperative bleeding and other serious complications.3.2.2RFA postoperative and preoperative peripheral blood cells (erythrocytes, leukocytes, platelets) to compare changes in the number of statistics, three-line values were lower (P<0.05).4. Conclusion4.1The hypersplenism animal model created by splenic vein ligation is suitable for animal spleen ablation; 4.2Radiofrequency ablation in treating the hypersplenism is effective;4.3Radiofrequency ablation can correct the number of erythrocytes, leukocytes, platelets caused by hypersplenism;4.4Spleen returned to normal need6weeks after RFA, the effect is clearly.4.5Radiofrequency ablation can be a kind of incision treatments of hyperthyroidism caused by portal hypertension.