两步法栓塞脾脏治疗胰源性门脉高压的初步研究

Two-step splenic artery embolization in the treatment of pancreatitis-induced portal hypertension

目的首次提出两步法脾动脉栓塞治疗胰源性门脉高压的治疗方法，并评价其可行性及治疗效果。方法9例胰源性门脉高压患者，其中5例合并间断黑便，分两次行介入脾脏栓塞。第一次，经脾动脉用PVA颗粒栓塞脾脏约60％～70％；间隔4～6周，再用PVA栓塞全部脾脏，并以弹簧钢圈栓塞脾动脉远端及近端。术后CT平扫及增强评价栓塞效果，临床随访患者情况。结果9例均成功行2次介入栓塞，未出现脾脓肿等严重并发症，CT复查见脾脏85％～100％梗死，曲张静脉减少或消失。随访20～35个月，患者未再发生上消化道出血症状。结论两步法栓塞脾脏可作为胰腺炎导致的胰源性门脉高压的有效手段，患者反应较轻并无严重并发症，尤其适用于不能耐受外科手术者。

Objective To evaluate the efficacy of two-step splenic artery embolization in the treatment of portal hypertension secondary to pancreatitis. Methods Splenic artery embolization was performed in 9 patients with portal hypertension secondary to chronic （7） and acute （2） pancreatitis using a two-step method. Partial splenic embolization was performed initially with the PVA particles to cause infarction of 60%-70% of the splenic parenchyma. After 4-6 weeks, the remaining spleen was embolized with PVA particles and the splenic artery was embolized using coils. The effect of embolization was assessed using CT and clinical followup. Results Splenic artery embolization was successfully performed in all patients without complications of splenic abscess. CT demonstrated 85%-90% infarction of the spleen and reduction or disappearance of the varices. During the 20-35 month follow-up, there was no upper gastrointestinal bleeding in any of the patients. Conclusions Two-step splenic artery embolization is effective in the treatment of pancreatitis-induced portal hypertension without complications.