The Investigation Of Clinical Comparison Between Partial Splenic Embolization And Percutaneous Radiofrequency Ablation Treatment For Hypersplenism Caused By Portal Hypertension In Cirrhosis

BackgroundHypersplenism is one of the most common complications of portal hypertension in cirrhosis. Spleen is an essential organ with multiple functions, while traditional splenectomy has obvious limitation and may cause complications. This treatment is gradually replaced by Partial splenic artery embolization (PSE), but PSE may still cause post-embolization syndrome, splenic abscess or other adverse reactions and complications. With the development of interventional radiology, increasingly numbers of radiofrequency ablation (RFA) treatments were reported for curing hypersplenism in recent years. This could create a new method of hypersplenism treatment. RFA may cause coagulation necrosis but not liquefaction necrosis of tissues. It is generally considered that RFA induces low chance of postoperative splenic abscess, inflammation and complications, therefore it is considered as safe treatment; while some others doubt about the efficacy of RFA for hypersplenism, and they think RFA has technical defect itself: the range of treatment cannot be accurate; the long-term effect is not clear; it may also induce numerous intraoperative complications and high-risk of abdominal bleeding. Therefore, it is intriguing to further investigate how the efficacies and advantages of these two methods for curing hypersplenism caused by portal hypertension in cirrhosis.Objective1. Comparative evaluations of the efficacies and safeties of PSE and RFA on leukopenia and thrombocytopenia induced by promoted hypersplenism in cirrhosis.2. Discussion of related impact factors of the efficacies and safeties PES and RFA on promoting hypersplenism in cirrhosis, thereby the references can be provided for patients to choose suitable treatment.Materials and methodsWith the approval of the Hospital Ethics Committee,60 patients cases with hypersplenism caused by portal hypertension in cirrhosis admitted from August,2012 to April,2014 were randomized after signing the informed consent. All those patients meet the inclusion criteria, and they were separated into PES group (control) and RFA group (experimental group). Routine blood tests and abdominal CT examinations were applied at time points of presurgery,1 week,1 month,3 months,6 months,1 year of postsurgery. Operative time, intraoperative adverse reaction, postoperative adverse reaction, admission time and hospital costs were recorded. Each parameter was statistically analyzed, and differences between groups were compared; thereby the related impact factors were analyzed and discussed.Results(1) The average operation time in PSE group is (1.2 ± 0.5) h, and that in RFA group is (3.8 ± 1.1) h; the operation time of RFA group is significantly longer than RSE group (P<0.05).(2) The average pain VAS score of PSE group is (1.2±0.9), and that of RFA group is (5.3±1.41); pain VAS score of RFA is significantly higher than RSE group (P<0.05).(3) The evaluation index of postoperative adverse reactions of PSE group is significantly higher than RSE group (P<0.05)(4) Spleen necrosis ratio of PSE group is 40%-80%, and the average value is (62.2±10.1)%, peripheral blood count at 1 week,2 weeks,1 month,3 months,6 months and 12 months of postsurgery are respectively improved by comparing with presurgery, and the differences has statistical significance (P<0.05).2 patient cases with spleen necrosis ratio of 50% below show a preoperative level of peripheral blood count at 12 months of postsurgery. Spleen necrosis ratio of RFA group is 20%-60%, and the average value is (30.7±10.2)%. Peripheral blood count at 1 week,2 weeks, 1 month and 3 month of postsurgery are respectively improved by comparing with presurgery, and the differences have statistical significance (P<0.05). The peripheral blood count decreased significantly at 6 months of postsurgery (P>0.05). The recrudescence of hypersplenism was occurred, and the peripheral blood count drop to preoperative level after 1 year. Among those patients,9 patients cases with 50%-60% of spleen necrosis ratio have maintained peripheral blood count in a comparable high level after 12 months. Improving of postoperative platelet and white blood cell count of PSE group is significantly better than RFA group (P<0.05)(5) The admission length of stay of PSE group is 15-100 days, and the average length is (22.3±3.7) days; the admission length of stay of RFA group is 10-30 days, and the average length is (16.8±5.2) days. The length of stay of PSE group is significantly longer than RFA group (P<0.05).(6) The average hospital cost of PSE group is 26212.71±31093.12 Yuan, and that of RFA group is 27391.23±19375.67 Yuan; no statistical difference between those two groups is found.Conclusions1. Both PSE and RFA have curative effects on patients with hypersplenism, and the postoperative efficacies of those two methods have a positive correlation with and spleen necrosis ratio.2. The postoperative adverse reactions and complications are positively correlated with spleen necrosis ratio in both PSE and RFA.PSE method has short intraoperative time and lesser adverse reactions; the embolization proportion of spleen is strictly controlled during surgery, therefore the chance of postoperative adverse reactions and complications can be remarkably reduced. RFA is limited by tools, materials and other reasons. In addition, ablation range of single injection is inadequate, and to extend the ablation range, patient may experience longer operation time and stronger agony, thereby the adverse reactions are increased. Among those two methods, PSE method is primarily selected as a treatment for hypersplenism caused by portal hypertension in cirrhosis.