超选择性栓塞脾动脉治疗脾功能亢进

Treatment with superselective splenic artery embolotherapy for hypersplenism

目的探讨超选择性分级栓塞脾动脉治疗脾功能亢进的临床价值。方法对32例脾功能亢进患者通过术前平扫或增强CT及术中脾动脉造影影像观察,确认脾实质供血明显丰富区域为主亢进区,其他区域为次亢进区,依次超选择性插管至脾动脉二级以下分支内,施行主亢进区完全栓塞、次亢进区部分栓塞及少量栓塞的分级栓塞方法,术后1周及1个月定期复查血常规,以评价近期疗效和并发症。结果脾动脉栓塞术后1周和1月外周血小板和白细胞数量明显增多,红细胞在术后1月后增多,和治疗前相比较差异有统计学意义(P<0.01)。术后出现低热32例,腹痛19例,无脾脓肿、胸腹水等严重并发症。结论超选择性分级栓塞脾动脉治疗脾功能亢进,可有效减少脾实质内血细胞池,近期可显著升高白细胞和血小板,术后反应轻微,并发症发生率低。

Objective To explore the clinical value of super-selective graded embolization of splenic artery in treatment of hypersplenism. Methods 32 patients with hypersplenism were verified as major hyperfunctional area with rich blood and the other as minor hyperfunctional area via plain or enhanced CT and splenic arteriography. Then, the major hyperfunctional area was completely embolised and the minor hyperfunctional area was partly embolised superselectively. After opreration, all patients were followed up to evaluate the short-term therapeutic effects. Results The peripheral platelets and leukocyte count increased in a week and a month, while the hemoglobin increased after one month. Difference of the number of peripheral platelet and leukocytes before and after embolisation was statistically significant ( P <0.01). 23 cases occurred low fever and 19 cases appeared abdominal pain, no other severe complications such as splenic abscess, hydrothorax and ascites happened. Conclusion Superselective splenic embolotherapy for hypersplenism can decrease the blood cell pool in spleen essence effectively, and promote the leukocyte and platelets growth remarkably. The postoperative reaction is slight, and the incidence of complications is low.