部分脾栓塞术治疗肝硬化并发脾功能亢进

Partial Splenic Embolization in the Treatment of Hepatic Cirrhosis Complicated with Hypersplenism

采用部分脾栓塞术(PSE)治疗肝硬化并脾功能亢进16例,疗效较满意。均将明胶海绵小粒经导管注入脾动脉3～4级分枝,本组栓塞面积为20～70%。PSE 后16例患者外周血细胞明显上升,15例随访6～18月仍稳定于正常范围(P<0.05)。PSE 后 WHVP 平均下降9.2cm H_2O(P<0.05)1例脾血流量下降58%。6月后脾脏缩小至正常大小,血清白蛋白平均上升15g/L。免疫功能无明显变化。主要副反应为左上腹痛,发热。1例术后20天死于原发性腹膜炎。本组资料表明 PSE 对控制脾亢,降低门脉压,改善肝功能确实有效,可部分取代切脾术。本文讨论了 PSE治疗肝硬化并脾亢的机理及栓塞面积问题。

Partial splenic embolization(PSE)was successfully accomplished in 16 patientswith liver cirrhosis,who had hypersplenism,splenomegaly and peripheral cytopenia.Tiny fragments of absorbable gelatin sponge were injected into the distal splenicartery through the catheter.20～70% splenic infarction was created.The peripheral blood count was increased obviously immediately in all patientsand kept in normal range in 6～18 months(P<0.05)in 15 cases after PSE.An averageWHVP reduction of 9.2cmH_2O(P<0.05)was obtained.The splenic flow was re-duced 58% in one case.The size of the spleen and liver function returned to normal.The immune function was unchanged.Fever and pain were main complications.Onlyone patient died of primary peritonitis on the twentieth day after PSE.The results confirmed that PSE was an effective way to controlling hypersple-nism,reduce portal pressure,improve liver function and hence an alternative tosurgery.The mechanism of PSE and the area of PSE was also discussed.