26例肝硬化脾功能亢进患者部分性脾栓塞术后肝脏早期血流状态变化分析

Analysis of early changes of hepatic blood flow after partial splenic embolization in 26 patients with liver cirrhosis and hypersplenism

目的分析肝硬化脾功能亢进患者部分性脾栓塞(PSE)术后肝脏血流动力学变化。方法回顾性分析2018年4月至2019年6月连续在宁夏医科大学总医院行PSE的26例肝硬化脾功能亢进患者资料,男性19例,女性7例,平均年龄55岁。比较患者PSE术前、术后1个月实验室指标以及全肝CT灌注成像测量的肝脏五叶肝动脉灌注量、门静脉灌注量、总肝灌注量和肝动脉灌注指数。结果26例患者术后白细胞计数、血小板计数高于术前,凝血酶原时间少于术前,差异均具有统计学意义(均P<0.05)。患者术后1个月肝左外叶、左内叶、右前叶、右后叶肝动脉灌注量分别为10.0(7.0,13.5)ml·min^-1·(100 ml)^-1、9.3(5.4,12.8)ml·min^-1·(100 ml)^-1、8.0(6.0,11.2)ml·min^-1·(100 ml)^-1、10.7(7.1,13.8)ml·min^-1·(100 ml)-1,高于术前7.7(4.2,11.0)ml·min^-1·(100 ml)^-1、6.9(2.6,10.2)ml·min^-1·(100 ml)^-1、7.1(4.1,8.7)ml·min^-1·(100 ml)^-1、5.9(4.4,8.5)ml·min^-1·(100 ml)^-1,差异均有统计学意义(均P<0.05)。全肝叶门静脉灌注量、总肝灌注量术前与术后比较,差异均无统计学意义(均P>0.05)。肝左外叶、右前叶、右后叶术后肝动脉灌注指数均高于术前,差异均有统计学意义(均P<0.05)。结论PSE不仅能有效缓解肝硬化患者脾功能亢进状况,同时也能增加肝动脉血流灌注,进而改善肝功能。

Objective To analyze the hepatic hemodynamics changes after partial splenic embolization in patients with cirrhosis and hypersplenism.Methods A total of 26 patients with cirrhosis and hypersplenism who underwent partial splenic embolization in the General Hospital of Ningxia Medical University from April 2018 to June 2019 were included in this study. The clinical data was retrospectively studied. The study objects consisted of 19 males and 7 females with an average of 55 years. Whole-liver perfusion enhanced CT imaging scan was performed for all patients. Changes in laboratory indexes and the blood perfusion of the liver sections including hepatic arterial perfusion, portal venous perfusion, total liver perfusion and hepatic arterial perfusion indexes before PSE and postoperative 1 month were compared.Results The postoperative leukocyte and platelet counts increased, and the prothrombin time decreased in the 26 patient, and the differences were significant (P<0.05). The hepatic arterial perfusion of the left lateral section, left medial section, right anterior section and right posterior section increased in postoperative 1 month, from 10.0 (7.0, 13.5) ml·min^^-1·(100 ml)^^-1, 9.3 (5.4, 12.8) ml·min^-1·(100 ml)^-1, 8.0 (6.0, 11.2) ml·min^-1·(100 ml)^-1, 10.7 (7.1, 13.8) ml·min^-1·(100 ml)^-1 to 7.7 (4.2, 11.0) ml·min^-1·(100 ml)^-1, 6.9 (2.6, 10.2) ml·min^-1·(100 ml)^-1, 7.1 (4.1, 8.7) ml·min^-1·(100 ml)^-1, 5.9 (4.4, 8.5) ml·min^-1·(100 ml)^-1, respectively. The differences were all significantly different (P<0.05). There were no significant difference in portal venous perfusion and total liver perfusion before and after operation (P>0.05). The hepatic arterial perfusion index of left lateral section, right anterior section and right posterior section increased after operation (P<0.05).Conclusion For patients with cirrhosis and hypersplenism who underwent partial splenic embolization, the state of hypersplenism was relieved, the hepatic arterial blood flow increased, and the liver function improved.