A Comparative Study of Surgical Splenectomy, Partial Splenic Embolization, and High‐Intensity Focused Ultrasound for Hypersplenism

Chen, Xijun; Hu, Xiaoru; Zhu, Hui; He, Chao

doi:10.7863/ultra.15.03050

Cited by 8 publications

(7 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Its noninvasive, nonradiative, and conformal thermal ablation effects, which comply with the developing requirements for the noninvasive treatment of tumors, all contribute to the appeal of this technique . Currently, HIFU has been proven to be effective in the treatment of solid tumors of multiple organs or tissues, such as bone, liver, pancreas, breast, uterus, prostate, and soft tissue …”

mentioning

confidence: 99%

Comparative Study of Pulsed Versus Continuous High‐Intensity Focused Ultrasound Ablation Using In Vitro and In Vivo Models

Wang

Luo

et al. 2019

J of Ultrasound Medicine

View full text Add to dashboard Cite

Objectives To compare the efficacy of pulsed high‐intensity focused ultrasound (PHIFU) versus continuous high‐intensity focused ultrasound (CHIFU) ablation at identical doses. Methods Continuous and pulsed HIFU (1200 J) at duty cycles (DCs) of 60% and 20% were examined for their capacity to ablate bovine liver tissue in vitro and rabbit liver tissue in vivo. After ablation, grayscale changes and pathologic characteristics were observed or measured, and the tissue necrosis volume, energy efficiency factor, and average grayscale density were calculated. Results The pulsed mode generated greater liquefaction necrosis. An inconspicuous grayscale change was observed for PHIFU at a DC of 20% in some samples, which appeared as an elliptical cavity. The energy efficiency factor of PHIFU at a DC of 60% was significantly lower than that of CHIFU, as observed both in vitro and in vivo (P < .05). The grayscale value and average grayscale density in response to CHIFU were significantly greater than those in response to PHIFU (60% or 20%; P < .05). Histopathologic analysis revealed liquefaction necrosis in all PHIFU groups. Conclusions At identical doses, compared with CHIFU, a single session of PHIFU can generate liquefaction necrosis and at a higher DC can improve ablation efficiency. This increased efficacy of PHIFU may involve enhancement of tissue destruction by cavitation effects and a reduction in the obstruction effect of endogenous microbubbles through cavitation effects or a more effective diffusion of heat.

show abstract

mentioning

confidence: 99%

Comparative Study of Pulsed Versus Continuous High‐Intensity Focused Ultrasound Ablation Using In Vitro and In Vivo Models

Wang

Luo

et al. 2019

J of Ultrasound Medicine

View full text Add to dashboard Cite

show abstract

“…Recently, investigators also aimed to use HIFU for the treatment of other diseases, such as secondary hypersplenism. Previous studies have investigated the safety and e cacy of HIFU in the treatment of secondary hypersplenism caused by cirrhosis [7].…”

Section: Discussionmentioning

confidence: 99%

“…This result is in accordance with those of previous studies. Zhu et al [7] reported that HIFU is safe and effective in the treatment of cirrhotic secondary hypersplenism in patients whose liver function is classi ed as Child-Pugh A or B. No major complications, such as gastrointestinal perforation, peritonitis, splenic rupture or abscess, occurred peri-HIFU and/or post-HIFU.…”

Section: Discussionmentioning

confidence: 99%

“…As an emerging noninvasive therapy, HIFU has been successfully applied to treat solid, well-de ned tumors, including those in the pancreas, liver, uterus, and prostate [4][5][6]. In recent years, HIFU has also been applied and proven to be safe and effective in the treatment of second hypersplenism caused by cirrhosis [7]. Although previous studies proved the safety and e cacy of HIFU in the treatment of secondary hypersplenism, neither the appropriate indications nor the relative contraindications for HIFU in the treatment of hypersplenism caused by cirrhosis have been clearly pointed out.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Minimally invasive treatment of cirrhotic secondary hypersplenism with high-intensity focused ultrasound

Zhang

Huang

et al. 2022

Preprint

View full text Add to dashboard Cite

High-intensity focused ultrasound (HIFU) has been reported to be a minimally invasive effective method for the treatment of secondary hypersplenism. However, neither the short-term efficacy nor the indications and/or contraindications have been described in patients with cirrhosis. From October 2019 to May 2021, eleven cases of patients with cirrhotic secondary hypersplenism were enrolled. The blood counts, liver function tests and abdominal ultrasound and/or MRI scans of all patients were closely evaluated. Among these 11 patients, eight (72.7%) patients were classified as Child-Pugh A, and the other 3 (27.3%) patients were Child-Pugh B; Five (45%) patients were diagnosed with gallstone, including multiple small stones in 2 patients and single stone in 3 patients. HIFU was performed successfully in all 11 patients. After HIFU, hematologic parameters and liver function were significantly improved in all 11 patients (p < 0.05). The HIFU ablated volume to spleen volume rate was 35%-61%. Complications were ecchymosis of the waist in 7 (63.3%) patients, ablated area pain in 3 (27.3%) patients, and choledocholithiasis in 2 (18.2%) patients with multiple small gallstones. All of them recovered smoothly without additional treatment except for 2 patients with choledocholithiasis recovered with risky endoscopic retrograde cholangiopancreatography (ERCP) treatment. This series suggested that HIFU is an effective and safe treatment for cirrhotic secondary hypersplenism in patients classified as Child-Pugh A or B. However, multiple small gallstones could be a relative contraindication for it.

show abstract

“…Its pathogenesis is due to the significantly enhanced phagocytosis of monocyte-macrophages accompanied by the destruction of blood cells after spleen enlargement, while a large number of blood cells are retained in the hyperplastic splenic sinus, which causes peripheral blood cytopenias [9][10][11]. The treatment of hypersplenism includes medical treatment, surgical treatment, and interventional therapy [12]. Medical treatment is mainly the use of drugs that stimulate blood cell growth, with good short-term efficacy and poor long-term efficacy.…”

Section: Discussionmentioning

confidence: 99%

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

Zheng

Liang

et al. 2021

BMC Gastroenterol

View full text Add to dashboard Cite

Background To investigate the safety and efficacy of 8Spheres in partial splenic embolization. To explore the possibility of accurate control of splenic embolic volume by quantifying the number of microspheres used during PSE. Method The data of 179 patients who underwent PSE were collected. The patients were divided into two groups: 300–500 um microsphere group (N = 83) and 500–700 um microsphere group (N = 96). The spleen volume before PSE, infarct volume and infarct rate of the spleen after PSE, changes in peripheral blood cells after PSE, postoperative adverse events and incidence of infection were compared between the two groups. Results 300–500 um group vs 500–700 um group: postoperative spleen volume (cm3): 753.82 ± 325.41 vs 568.65 ± 298.16 (P = 0.008); spleen embolization volume (cm3): 525.93 ± 118.29 vs 630.26 ± 109.71 (P = 0.014); spleen embolization rate: 41.1 ± 12.3% vs 52.4 ± 10.1% (P = 0.021). Leukocytes and platelets were significantly increased after PSE in both groups; leukocyte, 1 month: 4.13 ± 0.91 vs 5.08 ± 1.16 (P = 0.026); 3 months: 4.08 ± 1.25 vs 4.83 ± 0.98 (P = 0.022); platelet, 1 month: 125.6 ± 20.3 vs 138.7 ± 18.4 (P = 0.019); 3 months: 121.8 ± 16.9 vs 134.3 ± 20.1 (P = 0.017). Incidence of abdominal pain after PSE, 72 (86.7%) vs 69 (71.9%), P = 0.027. The incidence of other adverse events and infections after PSE was not statistically different. Conclusion PSE with 8Spheres is safe and effective. The use of 500–700 um microsphere for PSE can make the increase of peripheral blood cells more stable. Each vial of 8Spheres corresponds to a certain volume of splenic embolization, so it is possible to achieve quantitative embolization in PSE.

show abstract

A Comparative Study of Surgical Splenectomy, Partial Splenic Embolization, and High‐Intensity Focused Ultrasound for Hypersplenism

Abstract: High-intensity focused ultrasound has wide clinical indications for hypersplenism and may be safer than other treatment methods. Therefore, it is a good alternative procedure for patients with a high surgical risk.

Cited by 8 publications

References 28 publications

Comparative Study of Pulsed Versus Continuous High‐Intensity Focused Ultrasound Ablation Using In Vitro and In Vivo Models

Comparative Study of Pulsed Versus Continuous High‐Intensity Focused Ultrasound Ablation Using In Vitro and In Vivo Models

Minimally invasive treatment of cirrhotic secondary hypersplenism with high-intensity focused ultrasound

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

Contact Info

Product

Resources

About