部分脾动脉栓塞治疗艾滋病患者脾功能亢进的疗效评价

Clinical effects of partial splenic artery embolization for hypersplenism in AIDS patients

目的探讨部分脾动脉栓塞术治疗艾滋病毒（HIV）阳性患者肝硬化继发脾功能亢进的临床效果。方法6例HIV阳性肝硬化继发脾脏功能亢进患者，术前行B超、CT检查，常规行部分脾动脉栓塞术。分别检测患者术前、术后血细胞计数、肝功能以及门静脉血流动力学变化，监测术后并发症情况。结果术前血小板（PLT）、白细胞（WBC）和红细胞（RBC）分别为（58．3±15．0）×10^9／L、（2．24±0．58）×10^9／L和（2．97±0．78）×10^9／L，术后1周PLT、WBC明显升高（P〈0．05），红细胞变化不明显。术后1周丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）稍有升高，但2周恢复正常，白蛋白（ALB）术后均升高。部分脾动脉栓塞术（PSE）后门静脉内径、血流速度及血流量均较前减低，但差异无统计学意义（P〉0．05）。所有患者术后均无严重并发症发生。结论部分脾动脉栓塞术治疗HIV阳性肝硬化继发脾功能亢进可减轻患者血细胞减少，短期内肝功能恢复较好，未出现明显并发症。

Objective To explore the clinical effects of partial splenic artery embolization（PSE） hypersplenism secondary to liver cirrhosis in HIV positive patients. Methods A total of 6 HIV positive patients with hypersplenism secondary to liver cirrhosis were enrolled. There were 4 males and 2 females aging from 45 to 56 years old. All patients received PSE after the ultrasound and CT scan. The routine blood test,hepatic function and hemodynamics of the portal vein were also tested before or after operation. Results Preoperative PLT, WBC and RBC values were （58.3 ＋ 15.0） ~ 109/L, （ 2.24 -＋ O. 58 ） x 109/L and（2.97 ＋0.78） x 109/L,respectively. The PLT and WBC elevated significantly within the first week after PSE （ P 〈 0.05 ）, while RBC had no significant change. The ALT and AST slightly increased within the first week and got back to the normal level in the second week after operation. The ALB elevated with- in the 2 weeks after operation. The inner diameter of portal vein, blood flow velocity and blood flow were all reduced（P 〉 0.05 ）. All cases had no serious postoperative complications. Conclusion For hyper- splenism secondary to liver cirrhosis, PSE relieved the decline of blood cells in HIV positive patients. It maintained liver function in a short-term and had no obvious complications.