脾动脉栓塞(SAE)治疗门脉高压脾大脾亢12例

目的进一步讨论脾动脉栓塞在治疗门脉高压、脾大脾亢中的临床意义及相关问题,加强对这一方法的共识。方法学习文献,结合对本组病人治疗的方法、步骤及结果,综合分析,认真讨论。结果SAE后脾亢症状迅速缓解,PLT和WBC于第2d升高,PLT于7～10d达最高峰,2周开始回落,逐渐稳定在正常范围;WBC于5～7d达最高峰,1周后渐降至正常范围;PV直径在SAE后1W开始缩减,3周后稳定在0.8～1.2cm之间;脾脏于SAE后12周逐渐回缩至肋缘内;随访1～4年,12例中有8例存活,3例死于肝癌,1例死于非门脉高压并发症。存活8例中,无1例因门脉高压并发症或脾亢再住院。栓塞前有腹水或消化道出血者,均未复发,无一例出现肝性脑病。肝功进步,体力恢复,能够胜任一般生活劳动。结论SAE是治疗肝硬化PV高压、脾功能亢进、预防严重并发症的便捷方法,值得推广应用,甚至替代脾脏切除术。

Objctive Discuss further the clinical significance of splenic artery embolization in treatment portal hypertension and big spleen hyperactivity and related issues,this method is to strengthen the consensus.Methods Study literature,combining the method and the results of treatment group,the comprehensive analysis,discussion.Results Splenic hyperactivity symptoms rapid relief after SAE. PLT and WBC hoist in the first 2 day after SAE. PLT at 7～10 days to reach peak,at 2w begin to decrease and stable gradually in the normal range,At 5～7 days WBC reaches the highest,it drop gradually to normal after1W. The PV diameter in 1W after SAE has started to shrink and to stable in 0.8cm～1.2cm after 3W; Spleen was retracted gradually to costal margin in 12W after SAE.Follow-up 1～4 years,eight patients survived of 12 cases,3 patients died of liver cancer,1 patients died of complications no portal hypertension. Live in 8 cases,no 1 patients with portal hypertension complications or spleen hyperactivity again hospitalization. Before SAE are ascites or gastrointestinal bleeding without relapse.No one was hepatic encephalopathy. Hepatic progress,physical recovery,can be competent general life labor.Conclusion SAE is a convenient method of the treatment cirrhosis,PV hypertension and spleen hyperfunction and prevent serious complications. It is popularization,even substitution splenectomy.