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Hong W, Wang Z, Yao W, Zhang X, Zhang L, Liang B. Efficacy and Safety of Transarterial Chemoembolization and Repeated Partial Splenic Embolization for Hepatocellular Carcinoma with Hypersplenism and Thrombocytopenia. J Hepatocell Carcinoma 2024; 11:1065-1078. [PMID: 38882439 PMCID: PMC11179653 DOI: 10.2147/jhc.s455461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/30/2024] [Indexed: 06/18/2024] Open
Abstract
Aim Partial splenic embolization (PSE) combined with transarterial chemoembolization (TACE) has been reported in treatment of hepatocellular carcinoma (HCC) with cirrhotic hypersplenism and thrombocytopenia. However, efficacy and safety of repeated PSE when required are unclear. This study aims to investigate post-procedural changes in peripheral blood cell and hepatic function, progression-free survival (PFS), and safety of HCC patients with hypersplenism received TACE and repeated PSE compared to those received TACE alone. Methods This retrospective study included 102 HCC patients with hypersplenism who received TACE (n = 73) or TACE+PSE (n = 29) from January 2014 to December 2021. Changes in peripheral blood cell and hepatic function were investigated at 1 week, 2, 6, 12, 18, and 24 months. TACE procedure sessions and adverse events were recorded. PFS and prognostic factors were analyzed. Results Despite response to initial PSE being limited, repeated PSE increased platelet (PLT) again, which peaked at 18 months. It also continued to improve red blood cell (RBC) and hemoglobin, which showed significant differences in changes from baseline between two groups until 24 months, as well as Child-Pugh scores at 12 and 18 months. Mean TACE procedure sessions were significantly higher in TACE+PSE group than that in TACE alone group (4.55 vs 3.26, P = 0.019). TACE+PSE group had longer median PFS (19.4 vs 9.5 months, P = 0.023) than TACE alone group, where PSE was an independent protective factor (HR, 0.508; P = 0.014). Initial and repeated PSE showed no significant differences in safety. Conclusion Repeated PSE is effective in increasing PLT again and improving RBC, hemoglobin and liver function. It contributed to performing serial TACE procedures thereafter. TACE combined with repeated PSE has significantly longer PFS than TACE alone, where PSE was an independent protective factor. Moreover, the safety of repeated PSE was comparable to initial PSE.
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Affiliation(s)
- Wei Hong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, Hubei, People's Republic of China
| | - Zizhuo Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, Hubei, People's Republic of China
| | - Wei Yao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, Hubei, People's Republic of China
| | - Xin Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, Hubei, People's Republic of China
| | - Lijie Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, Hubei, People's Republic of China
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, Hubei, People's Republic of China
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Zhang JS, Li L. Laparoscopic ligation of splenic vessels for the treatment of hereditary spherocytosis in children. Pediatr Surg Int 2020; 36:365-371. [PMID: 31982941 DOI: 10.1007/s00383-020-04623-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Total splenectomy is the most effective surgical treatment for hereditary spherocytosis (HS). Nevertheless, post-splenectomy sepsis and hypoimmunity can pose a great risk to children. Some alternative treatments have been proposed to avoid the post-splenectomy complications. In this study, we propose such a procedure (laparoscopic ligation of splenic vessels, L-LSV) for the treatment of HS in children and investigate its effectiveness and feasibility. MATERIALS AND METHODS A total of 17 children with HS who underwent the L-LSV at our hospital between May 2015 and Apr 2018 were enrolled in the current study. All patients were followed-up for 3-38 months (mean 19.8 months). The volume of spleen was preoperatively and postoperatively measured using the AW VolumeShare5. The size of functional spleen and the condition of splenic infarction were evaluated using ultrasound and computed tomography (CT) after surgery. The routine blood, biochemistry and coagulation tests were carried out after surgery. RESULTS The L-LSV was successfully performed in all patients. The average operative time was 115 min (range 60-180 min). No patients underwent blood transfusion during surgery, and the length of hospital stay varied 5-9 days after surgery (mean 7 days). Postoperatively, the red blood cells, platelet and hemoglobin were significantly increased (P < 0.05). The postoperative volume of functional spleen was significantly smaller than preoperative volume of spleen (307.393 ± 177.634 cm3 vs. 581.242 ± 270.260 cm3, P = 0.000). The recent volume of functional spleen was significantly bigger than the postoperative 1 month volume of functional spleen in ten children who were followed-up for more than 1 year (P = 0.004). The index of splenic infarction (the proportion of the postoperative 1-month volume of splenic infarction in the preoperative volume of spleen) was 0.31-0.99 (mean 0.53). There were no patients undergoing the blood transfusion after surgery. CONCLUSIONS The L-LSV is an effective treatment for HS in children; however, future studies should re-evaluate the long-term prognosis.
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Affiliation(s)
- Jin-Shan Zhang
- Department of General Surgery, Capital Institute of Pediatrics, No. 2 Yabaolu Rd., Beijing, 100020, People's Republic of China
| | - Long Li
- Department of General Surgery, Capital Institute of Pediatrics, No. 2 Yabaolu Rd., Beijing, 100020, People's Republic of China.
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Kim NH, Kim HJ, Cho YK, Hong HP, Kim BI. Long-Term Efficacy and Safety of Partial Splenic Embolization in Hepatocellular Carcinoma Patients with Thrombocytopenia Who Underwent Transarterial Chemoembolization. J Korean Med Sci 2019; 34:e208. [PMID: 31373186 PMCID: PMC6676001 DOI: 10.3346/jkms.2019.34.e208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/07/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Performing transarterial chemoembolization (TACE) is difficult with the occurrence of thrombocytopenia in cirrhotic patients with hepatocellular carcinoma (HCC). We aimed to evaluate the long-term efficacy and safety of partial splenic embolization (PSE) combined with TACE in patients with HCC with severe thrombocytopenia related to splenomegaly. METHODS We conducted a case-control study consisting of 18 HCC patients with severe thrombocytopenia (< 50 × 10⁹/L) who underwent PSE concurrently with TACE (PSE group) and 72 controls who underwent TACE alone (non-PSE group). RESULTS Mean platelet counts at 1 month and 1, 3, and 5 years after concurrent PSE and TACE significantly increased compared with baseline (all P < 0.05), whereas the platelet count did not significantly increase after TACE alone. In addition, the platelet count at several time points after treatment in the PSE group was significantly higher than that in the non-PSE group, although the baseline platelet count in the PSE group was significantly lower than that in the non-PSE group. The platelet increase after PSE significantly reduced the need for platelet transfusions (P = 0.040) and enabled the subsequent TACE procedures in time (P = 0.046). The leukocyte counts and hemoglobin concentrations after concurrent PSE and TACE were also significantly increased, without deterioration of Child-Turcotte-Pugh score and unexpected side effects. CONCLUSION PSE combined with TACE is effective in inducing and maintaining long-term thrombocytopenia improvement which reduces the need for the platelet transfusion and helps to perform initial and serial TACE, and is well-tolerated in patients with HCC and thrombocytopenia. PSE may be a promising treatment option for HCC patients with severe thrombocytopenia associated with splenomegaly who will undergo TACE.
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Affiliation(s)
- Nam Hee Kim
- Preventive Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Kyun Cho
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Ik Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Huang JH, Morelli JN, Ai F, Zou RH, Gu YK, Gao F, Zhang TQ, Yao W, Jiang XY, Zhang YY. Hydrochloric acid-enhanced radiofrequency ablation for treating a large hepatocellular carcinoma with spontaneous rapture: a case report. CHINESE JOURNAL OF CANCER 2017; 36:1. [PMID: 28061892 PMCID: PMC5219733 DOI: 10.1186/s40880-016-0161-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/10/2016] [Indexed: 12/30/2022]
Abstract
Background A ruptured hepatocellular carcinoma (HCC) is often fatal. In addition to surgery and transarterial embolization, radiofrequency ablation (RFA) might be another option for treating a ruptured HCC. Unfortunately, conventional RFA has a limited ablation zone; as such, it is rarely used to treat ruptured tumors. Case presentation This case was a 60-year-old man who had a large, ruptured HCC in which hydrochloric acid (HCl)-enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic. Conclusion Considering the effectiveness of HCl-enhanced RFA in achieving hemostasis and tumor ablation, it might be a new option for treating large, ruptured HCCs.
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Affiliation(s)
- Jin-Hua Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, P. R. China.
| | - John N Morelli
- Department of Interventional Radiology, St. John's Medical Center, Tulsa, OK, 74131, USA
| | - Fei Ai
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, P. R. China
| | - Ru-Hai Zou
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, P. R. China
| | - Yang-Kui Gu
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, P. R. China
| | - Fei Gao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, P. R. China
| | - Tian-Qi Zhang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, P. R. China
| | - Wang Yao
- Department of Oncologic Interventional Therapy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Xiong-Ying Jiang
- Department of Radiology Intervention, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P. R. China
| | - Yan-Yang Zhang
- Department of Intervention, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, Guangdong, P. R. China
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Hepatectomy combined with microwave ablation of the spleen for treatment of hepatocellular carcinoma complicated with splenomegaly: A retrospective study. Mol Clin Oncol 2016; 6:204-208. [PMID: 28357095 DOI: 10.3892/mco.2016.1111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/04/2016] [Indexed: 12/14/2022] Open
Abstract
The present retrospective study aimed to investigate the mid-term safety and efficacy of hepatectomy combined with microwave ablation of the partial spleen for treatment of liver cancer complicated with hypersplenism. A retrospective analysis was performed on 23 patients who underwent hepatectomy combined with microwave ablation of the partial spleen for liver cancer, complicated with hypersplenism that was secondary to cirrhosis. The splenic and ablated volumes were calculated according to a contrast-enhanced computed tomography scan prior to and 2 weeks after the operation. Complete blood count and liver function tests were examined prior to and following the surgery, and complications and changes in the blood tests were monitored for 6 months. Over this period of investigation, the splenic volume was reduced by a mean value of 34.0%. The levels of serum alanine aminotransferase and aspartate aminotransferase were increased on the first day after the operation (P<0.05), although they recovered to the normal level within 1 week (P<0.05). The total level of bilirubin increased slightly, along with moderately decreased levels of albumin and cholinesterase on the first day, although these changes were not significant compared with the baseline (P>0.05). The white blood cell count was persistently significantly higher compared with the baseline over the course of the 6 months (P>0.05). The platelet count did not increase significantly for the first week after the operation (P>0.05); however, it was revealed to be significantly increased 1 month after the surgery (P<0.05). No significant complications were occurred during the follow-up period. In conclusion, hepatectomy combined with microwave ablation of the spleen was demonstrated to be a safe and effective procedure for patients with liver cancer and hypersplenism in the mid-term.
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Laparoscopic splenic vessels ligation as a treatment of hypersplenism and thrombocytopenia in children. Surg Endosc 2015; 30:3916-21. [PMID: 26659241 DOI: 10.1007/s00464-015-4698-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/17/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Splenectomy and partial splenic embolization as the surgical approach in the treatment of hypersplenism and thrombocytopenia have been reported. However, there are still some disadvantages in the application of these techniques. In this article, we propose a new technique for the treatment of hypersplenism and thrombocytopenia in children and report our preliminary experience. METHODS From Aug 2014 to Dec 2014, four children with hypersplenism and three children with idiopathic thrombocytopenic purpura were treated in our hospital. Laparoscopic splenic vessels ligation was performed in all patients. The gastric wall was suspended to expose the pancreatic tail and spleen, and the splenic artery was ligated at the superior border of the pancreas. The splenic venous branches were dissected and ligated at the splenic hilum using the Hem-o-lok. RESULTS The laparoscopic splenic vessels ligation was successfully performed in all patients. The average operative time was 126 min (range 120-150 min). No patient required transfusion, and the length of hospital stay varied from 4 to 11 days (mean 6.6 days). The patients were followed up for 6-10 months (mean 8.5 months). The complete blood counts were within normal range. The size of spleen decreased postoperatively. The partial splenic infarction and the reduction in splenic blood flow were confirmed in all patients by postoperative ultrasound and CT. CONCLUSIONS The laparoscopic splenic vessels ligation is a feasible option for treating hypersplenism and thrombocytopenia in children.
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Partial splenic embolization with transarterial chemoembolization in patients with hepatocellular carcinoma accompanied by thrombocytopenia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:960628. [PMID: 25298965 PMCID: PMC4179942 DOI: 10.1155/2014/960628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/31/2014] [Accepted: 09/02/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thrombocytopenia often makes the introduction of systemic treatment difficult in patients with cirrhosis and hepatocellular carcinoma (HCC). We retrospectively evaluated the long-term effects of partial splenic embolization (PSE) with transarterial chemoembolization (TACE) in patients with HCC patients accompanied by thrombocytopenia. PATIENTS AND METHODS Twenty-one patients with HCC complicated by severe thrombocytopenia (platelet count, <5.0 × 10(4)/mm(3)) were treated with PSE and TACE. Both the safety and platelet-increasing effect was evaluated in these patients. RESULTS Seventeen of 21 patients (81.0%) showed increased platelet counts to ≥5.0 × 10(4)/mm(3). Subsequently, 13 patients (61.9%) successfully received systemic chemotherapy. Platelet counts and serum levels of total bilirubin, as well as neutrophil counts, improved significantly one month after treatment. However, serum levels of albumin and hemoglobin decreased significantly one month after treatment. Severe adverse events, including acute liver failure and portal vein thrombus, were observed in two patients. CONCLUSION PSE with selective TACE made it possible for patients with HCC and severe thrombocytopenia to receive systemic chemotherapy. Although PSE with TACE was safe and tolerable for most patients, the extent of PSE with TACE in a wide area of the liver may increase the risk for fatal liver failure.
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Litvak DA, Malad S, Wascher RA, Markman M, Niu J. Laparoscopic Splenectomy in Colorectal Cancer Patients with Chemotherapy-Associated Thrombocytopenia due to Hypersplenism. Case Rep Oncol 2012; 5:601-7. [PMID: 23275773 PMCID: PMC3531924 DOI: 10.1159/000345413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Hypersplenism due to chemotherapy-related liver injury has been associated with severe thrombocytopenia that may preclude continuation of systemic therapy for cancer patients. Patients treated for metastatic colorectal cancer (mCRC) are among the most common patients affected by hypersplenism. Cessation of systemic therapy invariably leads to progression of disease. While partial splenic embolization has been employed successfully to reverse the effects of hypersplenism, the role of laparoscopic splenectomy for this problem has not been completely defined. Methods A retrospective review was conducted of mCRC patients treated with laparoscopic splenectomy at our institution to reverse severe thrombocytopenia due to chemotherapy-related hypersplenism. An endpoint assessed was the ability to resume therapy after splenectomy. Results Six patients with mCRC and hypersplenism requiring cessation of systemic therapy underwent laparoscopic splenectomy. All (6) patients had a postsurgical platelet count >150 × 103/μl and resumed chemotherapy after surgery. Median platelet count prior to surgery was 66 × 103/μl, and just prior to resuming systemic therapy it was 399.5 × 103/μl. Median spleen size was 14.0 cm. There were no surgical complications. Mean hospital stay was 2.8 days and the median time from surgery to resumption of therapy was 23.5 days. Conclusions Laparoscopic splenectomy appears to offer selected patients with mCRC the opportunity to resume systemic therapy that otherwise would be discontinued due to thrombocytopenia from hypersplenism.
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Affiliation(s)
- David A Litvak
- Department of Surgery, Cancer Treatment Centers of America at Western Regional Medical Center, Goodyear, Ariz., USA
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Gao F, Gu YK, Shen JX, Li CL, Jiang XY, Huang JH. Experimental study of destruction to porcine spleen in vivo by microwave ablation. World J Gastroenterol 2011; 17:5014-20. [PMID: 22174552 PMCID: PMC3236583 DOI: 10.3748/wjg.v17.i45.5014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 05/06/2011] [Accepted: 05/13/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To discuss the safety, feasibility and regularity of destruction to porcine spleen in vivo with congestion and tumescence by microwave ablation (MWA).
METHODS: Ligation of the splenic vein was used to induce congestion and tumescence in vivo in five porcine spleens, and microwave ablation was performed 2-4 h later. A total of 56 ablation points were ablated and the ablation powers were 30-100 W. The ablation time (1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 min) was performed at a power of 60 W. After ablation, the ablation size was measured in pigs A, C, D and E and spleen resection. In pig B, the ablation size was measured and 2 ablation points were sent for pathology analysis and all tissues were sutured following ablation. Pig B was killed 1 wk later and the ablation points were sent for pathology analysis. Bleeding, tissue carbonization surrounding electrodes, and pathological changes were observed, and the effect on destruction volume relative to different ablation powers, times and positions was analyzed.
RESULTS: The incidence of bleeding (only small am-ounts, < 20 mL) in the course of ablation was 5.4% (3/56) and was attributed to tissue carbonization surrounding electrodes, which also exhibited an incidence of 5.4% (3/56). The destruction volume was influenced by different ablation powers, times and points. It showed that the ablation lesion size increased with increased ablation time, from 1 to 10 min, when the ablation power was 60 W. Also, the ablation lesion size increased with the increase of ablation power, ranging from 30 to 100 W when the ablation time was set to 3 min. A direct correlation was seen between the destruction volume and ablation time by the power of 60 W (r = 0.97542, P < 0.0001, and also between the destruction volume and ablation powers at an ablation time of 3 min (r = 0.98258, P < 0.0001). The destruction volume of zone II (the extra-2/3 part of the spleen, relative to the first or second class vascular branches), which was near the hilum of the spleen, was noteably larger than the destruction volume of zoneI(the intra-1/3 part of the spleen) which was distal from the hilum of the spleen (P = 0.0015). Pathological changes of ablation occurring immediately and 1 wk after MWA showed large areas of coagulation. Immediately following ablation, intact spleen tissues were observed in the areas of coagulation necrosis, mainly around arterioles, and there were no obvious signs of hydropsia and inflammation, while 1 wk following the ablation, the coagulation necrosis was well distributed and complete, as many nuclear fragmentations were detected, and there were obvious signs of hydropsia and inflammation.
CONCLUSION: In vivo treatment of congestion and tumescence in the spleen using microwave ablation of water-cooled antenna is a safe and feasible method that is minimally invasive.
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