部分性脾动脉栓塞治疗脾功能亢进(附5例报告)

Partial splenic embolization in the treatment of hypersplenism

报告了部分性脾动脉栓塞治疗脾功能亢进血小板减少症５例，男２例，女３例。平均年龄４３岁。Ｓｉｌｄｉｎｇｅｒ法穿刺股动脉，经导管脾动脉造影后，注入１ｍｍ明胶海绵颗粒１０～３０粒，栓塞面积４０％～７０％。术后白细胞平均升高３６×１０９／Ｌ，血小板平均升高１１０×１０９／Ｌ，峰值在７～１４ｄ。症状有左上腹轻痛、发热、恶心，未出现脾脓肿及异位栓塞。２例原发性者术后追踪１年无复发，３例肝硬化门脉高压症继发者，其中１例２个月后复发行第２次栓塞，半年后又有复发，原因可能为：①脾脏增大程度不一，栓塞面积不足；②肝硬化门脉高压进行性加重，残余脾代偿增大；③抗血小板抗体形成因素持续存在。病例疗效提示，部分性脾栓塞损伤小，并发症少，并可保留脾脏免疫功能。

Partial splenic embolization (PSE) was performed in treatment of 5 cases hypersplenism(mean age:43 years,age range:14～67 years).Following splenic angiography transcatherter percutaneously,10～30 particules of 1mm gelfoam matter were imjected into the splenic artery.The block area was range of 40%～70%.The average value of WBC raised to 36×109/L and PLT raised to 110×109/L with the peak during 7～14 days post emboligation.There were such clinical symptoms as slight pain on left upper abdomen,fever,nausea.The splenic abscess and displaced embolism did not occur in this group.In one of three portal hypertension cases caused by cirrhosis of liver,the hyperslenism recurred within 2 months after PSE and therefore second PSE was performed.In the two primary cases of childen,there was no recurrence after one-year follow-up.The clinical effect showed that PSE only produced little harm and a few of complication,but partial spleen immune function was kept. The effect of PSE on treatment of the primary cases was better than that of the secondary ones.