摘要
目的探讨部分脾栓塞术(Partial Splenic Embolization,PSE)治疗肝硬化脾功能亢进症的临床疗效及其并发症的防治。方法126例肝硬化并发门脉高压及脾功能亢进症患者,采用Seldinger技术行PSE,用明胶海绵作栓塞剂。术前、后定期复查血常规,测定脾脏长径、厚度及门脉主干及脾静脉内径,观察并发症。结果栓塞面积<30%者8例;30%～60%者66例;60%～80%者42例;>80%者10例。除8例栓塞面积<30%者外,术后患者的外周血细胞均逐步上升,术后1周患者WBC(×109·L-1)、PLT(×109·L-1)、HGB(×g·L-1)分别为7.58±4.52、76.35±28.47、98.36±15.72(P<0.01,vs术前白细胞2.57±0.62、血小板36.63±8.42,P>0.05vs术前血红蛋白96.58±13.46)。术后1月患者的WBC、PLT及HGB分别为4.48±0.86,91.49±38.20及124.46±30.84(P<0.01,vs术前的WBC、PLT及HGB)。术后3～6月超声测定118例脾脏长径、厚度(cm)分别为14.32±3.26,5.68±1.12(P<0.05,vs术前的17.42±2.65,7.54±2.14)。栓塞面积<30%者无并发症,栓塞面积30%～60%者4例(4/66)发生并发症;栓塞面积60%～80%者27例(27/42)发生并发症;栓塞面积大于>80%者均出现并发症(10/10)。并发症包括胸水、腹水、顽固性呃逆、左下肺炎、脾脓肿、脾囊肿、门脉血栓、膈下脓肿等。并发症的发生率及严重程度与脾脏栓塞的面积密切相关(P<0.01)。结论PSE能有效缓解肝硬化患者的脾功能亢进症,掌握合适的栓塞面积可减少并发症的发生率,术前充分准备、术后加强抗炎及对症处理可减少或减轻并发症的发生。
Aim To study the clinical effects of partial splenic embolization （PSE） in patients with hypersplenism of cirrhosis, observe the prevention and treatment of side effects of PSE. Methods One hundred and twenty six patients with hypersplenism and portal hypertension complicated with hepatic cirrhosis received Seldinger＇s technology partial splenic embolization using sponge. Blood routine analysis, splenic length and thickness assay, portal and splenic vein internal diameter assay were tested regularly pre-PSE and post-PSE, and complications were observed and treated. Results Embolismic area was less than 30% in 8 patients, 30% -60% in 66 patients, 60% -80% in 42 patients and more than 80% in 10 patients. Except 8 patients of less than 30% , other patients blood cells were raised obviously. One week after PSE, white blood cell （WBC, × 10^9 · L^-1） and platlet （PLT, × 10^9 · L^-1） were 7.48 ±3.52, 86.35±38.47 respectively （P 〈 0.01, vs 2. 17 ± 0.46, 35.63 ± 8.42,pre - PSE）, hemoglobin（HGB, × g· L^-1 ） was 104.36 ± 16.72 （P 〉 0.05, vs 98.58 ± 17.46, pre-PSE）. One month after PSE, blood WBC, PLT and HGB were 4.48 ±0.56,121.49 ±28.20 and 124.46 ± 10.84 respectively （P 〈 0.01 ,vs 7.48 ± 3.52, 86.35 ± 38.47 and 98.58 ± 17.46,pre- PSE）. Post-PSE from three to six months, splenic length and thickness（cm） in 118 patients with embolismic area more than 30% were 14.32±3.26, 5.68±1.12 respectively （P〈0.01, vs 17.42 ±2.65, 7.54±2.14, pre-PSE）. Complications were found in 41 patients （41/126） , 4 of them were from 66 patients with 30% -60% embolization area, the rate was 6.06% ; 27 of them were from 42 patients with 60% -80% , the rate was 64.29% ; another 10 patients were from 10 patients with more than 80% , the rate was 100%. Those complications included hydrothorax, ascites, pertinacious, left lower pneumonia, splenic and ubphrenic abscess. The incidence and severity of complications after PSE were related directly to the embolization extent （ P 〈 0. 01 ）. Conclusion PSE was effective in improving hypersplenism and reducing portal hypertension. Proper extent of embolization may decrease the incidence rat of complications, intensive anti-infection .
出处
《胃肠病学和肝病学杂志》
CAS
2007年第1期78-81,共4页
Chinese Journal of Gastroenterology and Hepatology
关键词
部分脾栓塞
肝硬化
门脉高压
脾功能亢进
治疗
Partial Splenic Embolization
Liver cirrhosis
Portal Hypertension
Hypersplenism
Treatment
