部分性脾栓塞术在门静脉高压症合并疾病中的应用价值

The application value of partial splenic embolization in the treatment of portal hypertension complicating other diseases

目的:总结部分性脾栓塞术(partial splenic embolization,PSE)治疗门静脉高压症合并恶性肿瘤及其他疾病的价值。方法:分析近3年来PSE治疗的64例门静脉高压症合并其他疾病患者的临床资料。其中男51例,女13例。年龄29~82岁,中位年龄56岁。肝硬化由乙肝病毒感染引起55例,丙肝病毒感染引起6例,非病毒性肝病后肝硬化3例。64例患者血小板数量为11×109/L^63×109/L,平均(36.4±14.5)×109/L;7例患者少至中等量胸和/或腹水。患者合并恶性肿瘤63例,合并尿毒症1例。本组患者以明胶海绵为栓塞剂行PSE。结果:64例患者PSE后2周内血小板最高值在83×109/L^453×10 9/L,平均(176.7±80.8)×109/L,较栓塞前差异极其显著(P<0.001)。PSE后并发症为60例有左上腹疼痛,37例伴发热,新出现腹水6例,既有腹水加重4例,对症治疗后症状消失。63例合并恶性肿瘤患者血小板升高后完成了放化疗为主的抗癌治疗,1例尿毒症患者得以顺利置管维持血透。结论:PSE可明显改善门静脉高压症引起的血小板减少症和浆膜腔积液,使合并的恶性肿瘤和其他疾病得以治疗。

Objective： To sum up the value that partial splenic embolization（PSE） treats portal hypertension complicated with malignant tumors and other diseases. Methods： The clinical data of 64 cases with portal hypertension and other diseases were analyzed in recent three years. Sixty-four patients included 51males and 13 females with media age of 56 （29 82） years. Fifty-five cases with cirrhosis were caused by hepatitis B virus and 6 by hepatitis C virus and 3 by non hepatitis virus. Thrombcyte counts were 11 ×10^9/L - 63×10^9/L and the average was （36.4±14.5）×10^9/L. Seven cases had small to moderate amount of hydrothorax and/or ascites. Sixty-three patients suffered from complicated malignant tumors and one had uremia. Splenic artery embolization was used with sponge pieces. Results： The highest thrombcyte counts of all patients were 83×10^9/ L - 453×10^9/L and the average was （176.7±80.8）×10^9/L, the difference was obvious （P〈0.001） before and after PSE. The complication of pain occurred in 60 cases, fever in 37 cases, new occurrences of ascites in 6 cases, and ascites became serious in 4 cases. All of the symptoms disappeared after treatment. Sixty-three cases with malignant tumors were treated with radiotherapy and chemotherapy-based anti-cancer therapy after thromobcyte count rising. Catheter was successfully placed in one patient with uremic so that hemodialysis could be maintained. Conclusion： PSE can improve thrombocytopenia and effusion resulting from portal hypertension, which makes the malignant tumors and other diseases be treated.