部分脾动脉栓塞治疗肝硬化脾功能亢进90例临床分析

The clinical efficacy of the partial spleen artery embolization on the treatment of hypersplenism in 90 hepatic cirrhosis patients

目的观察部分脾动脉栓塞术（PSE）治疗肝硬化脾功能亢进的临床疗效。方法回顾性研究90例肝硬化脾功能亢进患者,行部分脾动脉栓塞术后1-4年,观察术前与术后血常规、脾脏体积、门脉内径、门静脉及脾静脉血流动力学、肝功能改变以及并发症。结果 90例肝硬化脾功能亢进患者术后白细胞、血小板计数较术前明显增加（P〈0.05）,术后3个月脾脏逐渐缩小,6个月内明显缩小（P〈0.01）。门脉内径缩小,术后不同时期门、脾静脉血流动力学具有明显改善。肝功能无影响。83例术后有左上腹疼痛、发热,10例出现胸、腹水,5例出现左侧肺炎。结论 PSE治疗肝硬化并发脾功能亢进可显著改善脾功能亢进症状,降低门静脉压力,减少消化道出血风险,不影响肝功能,延长生存期,远期效果显著且稳定,是创伤小、安全有效的治疗方法。

Objective To observe the clinical curative efficacy of the partial spleen artery embolization（ PSE） on the treatment of hypersplenism with hepatic cirrhosis. Methods 90 cases with hepatic cirrhosis and hypersplenism treated by PSE were retrospectively analyzed. The changes of blood routine,spleen size,portal vein diameter,the hemodynamics of portal vein and splenic vein,and the incidence of complications were observed and compared between preoperative and postoperative PSE from one to four years.These parameters were detected by biochemistry test and Color Duplex Dopper. Results At clinical observation for these patients,these parameters were improved to different extent compared with pre-operation. White blood cell and platelet count in PSE post-operation were significantly increased（ P〈0. 05）. Spleen gradually diminished after 3 months of past-operation and there had statistical significance in 6 months（ P〈0. 01）. Portal vein diameter also reduced. Moreover,the hemodynamic changes of portal vein and splenic vein were improved obviously. Additionally,some complications were occurred including left epigastric pain and fever in 83 cases,ascites /pleural effusion in 10 cases and left-side pneumonia in 5 cases. Conclusion PSE could improve hypersplenic symptoms significantly,reduce the portal vein pressure,decrease the risk of gastrointestinal bleeding with stable long term effect,suggesting PSE is an ideal operative mode with less trauma,safety and effectivity to treat hyperslpenism with hepatic cirrhosis.