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Influence on Spleen Immune Function of Quantitative Microwave Ablation for Hypersplenism
Ya Qi Duan Yong Yan Gao Yang Wang Xiao Xia Ni Lei Feng Ping Liang
Department of Diagnostic Ultrasound, Chinese PLA General Hospital, No. 28 Fu Xing Road, Beijing 100853, PR China
Purpose: To investigate the long-term influence on immune function of quantitative microwave ablation for secondary splenomegaly and hypersplenism.
Materials and methods: Patients with secondary splenomagely and hypersplenism were performed by microwave ablation of the spleen. Changes of T lymphocyte subsets, CD19+ lymphocyte and natural killer cell were detected before and after operation. T lymphocyte subsets, CD19+ lymphocyte and natural killer cell were detected by flow cytometry.
Results: CD19+ lymphocyte increased obviously at each occasion after microwave ablation therapy compared with pre-operation level. Patients’ level of CD3, CD3+CD4+ increased significantly 1 month after microwave ablation, but decreased slightly 3 months after operation. There were no significant change of CD3+CD8+,CD4/CD8 and NK cell level 1 and 3 months after operation compared with pre-operation level.
Conclusions: Microwave ablation therapy for splenomegaly and hypersplenism preserve part of the anatomic structure of the spleen and maintain its physiological function especially the immune function, and in the long-term it can partly increase the spleen immune function. From immune point of view, we can say that it is safe and effective.
Key words: Microwave ablation therapy, hypersplenism, splenomegaly, immune function
解放军总医院超声科自94年起开展微波治疗肝癌的大量基础和临床研究,在微波凝固治疗肝癌的研究中取得了令人鼓舞的结果[1-4]。 微波对生物组织加热是内源性加热，它具有良好的凝固和止血效果,并且热效率高、升温速度快、高温热场较均匀、消融范围较可靠。利用微波的这些特性将其应用范围进一步扩展到脾大、脾亢的治疗中。通过动物实验和初步的临床研究,证实微波部分消融脾组织治疗脾大、脾功能亢进的方法是安全、可行及有效的。然而,脾脏作为重要的免疫器官,在微波热消融后对免疫功能的影响迄今研究不多。现将我们研究组在这方面的初步研究结果报告如下。
1. 资料与方法
1.1 研究对象 肝硬化、脾大脾亢患者，年龄32－67岁，平均年龄（51.6±3.7）岁；均有乙肝病史，肝功能Child分级全部为A级。所有患者于治疗前填写治疗单并由本人或其家属签字同意。
1.2 主要仪器
1.2.1微波治疗仪 KY-2000微波消融治疗仪,南京康友微波能研究所，微波发射频率为915MHz， 功率范围0－100瓦。
1.2.2超声诊断仪 Acuson Sequoia 512 型超声仪，2.5-4MHz探头，配有穿刺导向器。
1.2.3流式细胞仪 FACSCalibur 美国BD公司。
1.3 方法与步骤
1.3.1 超声引导下经皮穿刺:患者右侧卧位，彩超引导避开可视血流择点定位，常规消毒铺巾，1%盐酸利多卡因局麻，嘱病人屏气配合，15G微波天线直入脾中下部背侧预定部位，静脉给药实施全麻，启动微波治疗仪，作用功率及作用时间为70－80W10－25分钟。再退针2－4cm，微波继续作用，直至脾包膜下，消融完毕后，出针时凝固针道，防止出血。消融完毕后即刻，超声探查腹腔有无液性暗区，监测有无出血。
1.3.2 腹腔镜下: 全麻后行气管插管，左背部垫高30°斜位。脐上缘穿刺建立气腹后,30°角腹腔镜探查腹腔,左中下腹腋前线及剑突下分别做另外两个切口。游离暴露脾脏下极后，消融电极经皮刺入腹腔，再在腔镜监视下自下极或背侧进入脾脏，开始消融，烧灼一次后退2cm，再烧灼，直至脾包膜下，再烧灼针道防止出血后退出。
1.4免疫细胞的检测 全部患者均于治疗前1天、治疗后3天、7天、1个月、3个月抽取外周静脉血，并置于肝素抗凝管内送检。采用流式细胞仪（FACSCalibur 美国BD公司）Simulset软件检测。T淋巴细胞亚群检测试剂盒:美国Becton-Dickinson（BD）公司Simultest IMK Lymphocytes Kit 检测试剂盒。
1.5统计学处理
统计分析采用Stata7.0软件，计量资料以均数±标准差（ .gif) ±SD）表示，治疗前后比较采用方差分析 。P<0.05差异有统计学意义。
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