Partial splenic embolism for cancer patients with pseudocirrhosis induced thrombocytopenia
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摘要: 目的 部分性脾栓塞(partial splenic embolization，PSE)可用于各种肝病引起的脾功能亢进，本研究旨在回顾小结PSE对肿瘤相关假性肝硬化所致血小板减少症(pseudocirrhosis induced thrombocytopenia，PIT)患者的有效性及安全性。 方法 回顾性分析2023年1月—2024年10月确诊为PIT并因需继续系统抗肿瘤治疗而行PSE的患者9例，记录患者资料、病史、检查结果及不良反应。研究主要终点为患者外周血血小板计数大于100×109/L，次要终点为患者接受再次系统抗肿瘤治疗。 结果 9例肿瘤相关PIT患者均接受单次PSE(男5例，女4例，年龄34~72岁，平均57.8岁)，技术成功率为100%。所有患者均达到了主要和次要研究终点。平均血小板计数从术前最低(36.67±13.96)×109/L显著增加至(132.22±31.00)×109/L的峰值水平，术后1周、1个月平均血小板计数分别为(74.44±23.26)×109/L和(118.67±17.97)×109/L。9例患者均接受再次系统抗肿瘤治疗，7例(78%)在术后1个月内进行。未发生非靶器官栓塞，1例患者出现3级不良反应，总胆红素上升至131 μmol/L，考虑与其合并胆囊结石相关。所有患者均出现轻至中度栓塞后综合征，对症治疗后可缓解。 结论 对于肿瘤相关PIT患者，PSE是一种安全有效的治疗方式，有助于患者恢复血小板计数，并继续行系统抗肿瘤治疗。
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关键词:
- 脾功能亢进 /
- 假性肝硬化 /
- 部分性脾栓塞 /
- 肿瘤治疗所致血小板减少症 /
- 假性肝硬化所致血小板减少症
Abstract: Objective Partial splenic embolism(PSE) has been safely and widely used for hypersplenism caused by various liver diseases. The purpose of this study was to review and summarize the effectiveness and safety of PSE in cancer patients with pseudocirrhosis induced thrombocytopenia(PIT). Methods A total of 9 patients diagnosed with PIT and undergoing PSE due to the need for continued systemic anti-tumor therapy from January 2023 to October 2024 were retrospectively analyzed. Clinical data, medical history, examination results, and adverse events of patients were recorded. The primary endpoint of the study included a platelet count increase>100×109/L, and the secondary endpoint was the initiation of systemic anti-tumor therapy. Results PSE was performed in 9 patients with tumor related PIT(5 males, 4 females; aged 34-72 years, with an average of 57.8 years), and the technical success rate was 100%. Primary and secondary endpoints were achieved in all patients. The mean platelet count significantly increased from (36.67±13.96)×109/L before PSE to a peak level of (132.22±31.00)×109/L. The mean platelet counts at 1 week and 1 month after PSE were (74.44±23.26)×109/L and (118.67±17.97)×109/L respectively. All patients could receive systemic anti-tumor therapy once again, with 7 patients (78%) within 1 month after surgery. No non-target embolization occurred, and one patient experienced a grade 3 adverse event with an increase in total bilirubin to 131 μmol/L due to his gallstones. All patients experienced a mild to moderate postembolization syndrome, which can be relieved with supportive treatment. Conclusion PSE is a safe and effective treatment for cancer patients with PIT. The platelet count is restored and patients are able to continue systematic anti-tumor treatment. -
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表 1 患者临床特征及血小板恢复情况
编号 性别 年龄/岁 原发肿瘤 既往治疗药物 栓塞体积/% 血小板计数/(×109/L) 血小板恢复时间/d 再次抗肿瘤治疗时间/d 持续抗肿瘤治疗时间/月 术前低值 术后峰值 1 男 34 结肠癌 L-OHP、5-Fu、CPT-11、CF、Bev 30 50 200 3 14 8 2 女 51 胆管癌 GEM、DDP、Durvalumab 50 49 157 34 34 7+ 3 男 72 结肠癌 L-OHP、5-Fu、CF、Bev 50 46 108 18 18 2+ 4 男 52 结肠癌 L-OHP、5-Fu、CF、Bev 40 44 122 21 21 6+ 5 女 69 胃癌 L-OHP、S-1 60 27 127 11 14 9 6 女 51 结肠癌 L-OHP、5-Fu、CF、Bev 60 23 109 11 14 6 7 男 53 直肠癌 L-OHP、5-Fu、CPT-11、CF、Bev 40 48 102 23 23 5+ 8 男 67 结肠癌 L-OHP、5-Fu、CF 50 32 145 21 21 6+ 9 女 71 乳腺癌 EPI、CTX、DOC、TAM、Pyrotinib 60 11 120 45 45 11 注：L-OHP：奥沙利铂；5-Fu：氟尿嘧啶；CPT-11：伊立替康；CF：亚叶酸钙；Bev：贝伐珠单抗；GEM：吉西他滨；DDP：顺铂；Durvalumab：度伐利尤单抗；S-1：替吉奥；EPI：表柔比星；CTX：环磷酰胺；DOC：多西紫杉醇；TAM：他莫昔芬；Pyrotinib：吡咯替尼。 
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表 2 患者随访情况
平均值 术前1周 术后1周 术后1个月 术后2个月 血小板计数/(×109/L) 43.33 74.44 118.67 114.00 白细胞计数/(×109/L) 3.67 9.74 4.64 4.73 血红蛋白/(g/L) 113.78 108.89 104.11 105.56 丙氨酸氨基转移酶/(U/L) 29.31 64.31 47.01 36.91 门冬氨酸氨基转移酶/(U/L) 51.70 94.01 53.70 47.40 白蛋白/(g/L) 39.51 36.16 36.93 37.69 总胆红素/(μmol/L) 22.88 46.07 28.69 26.72 肌酐/(μmol/L) 64.80 63.54 59.23 64.94
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