不同直径微球脾动脉栓塞治疗脾功能亢进疗效观察

Efficacy of splenic artery embolization with microspheres of different diameters in the treatment of hypersplenism

目的:观察不同直径微球脾动脉栓塞治疗脾功能亢进的疗效。方法:选取2020年1月—2021年12月肝硬化脾功能亢进患者100例,根据栓塞微球直径不同分为高直径组33例、中直径组34例及低直径组33例。高直径组采用直径为500~700μm微球栓塞,中直径组采用直径为300~500μm微球栓塞,低直径组采用直径为100~300μm微球栓塞。比较三组患者栓塞术前、术后第3天、术后1个月及术后3个月的白细胞、血小板水平和脾脏厚度、肋下长度变化、不良反应及并发症。结果:三组患者术后第3天、术后1个月及术后3个月白细胞均高于术前,术后3个月低于术后第3天及术后1个月(P<0.05);中直径组术后第3天、术后1个月及术后3个月白细胞低于其他两组(P<0.05);三组患者术后第3天、术后1个月及术后3个月血小板均高于术前,术后3个月高于术后第3天及术后1个月(P<0.05);中直径组术后第3天、术后1个月及术后3个月血小板高于其他两组(P<0.05);三组患者术后第3天脾脏厚度及肋下长度比较,差异无统计学意义(P>0.05);术后1个月三组患者脾脏厚度及肋下长度较术后第3天及术前缩短,且术后3个月较术后1个月缩短(P<0.05);中直径组患者脾脏厚度及肋下长度短于其他两组(P<0.05);三组患者不良反应及并发症总发生率由低到高分别是中直径组,高直径组,低直径组,差异有统计学意义(P<0.05)。结论:采用直径为300~500μm微球进行脾动脉栓塞效果最好,且并发症及不良反应较少。

Objective:To investigate the efficacy of splenic artery embolization with microspheres of different diameters in the treatment of hypersplenism.Methods:A total of 100 patients with liver cirrhosis and hypersplenism in hospital from January 2020 to December 2021 were selected.According to the diameter of the embolized microspheres,patients were divided into high diameter group(n=33)and medium diameter group(n=34)and low diameter group(n=33).The high diameter group used 500~700μm diameter microspheres for embolization,the medium diameter group used 300~500μm diameter microspheres for embolization,and the low diameter group used 100~300μm diameter microspheres for embolization.The levels of white blood cells and platelets,changes in spleen thickness and subcostal length,adverse reactions and complications before embolization,3 days after operation,1 month after operation,and 3 months after operation were compared among the three groups of patients.Results:The white blood cell levels of the three groups of patients were higher at 3 days,1 month and 3 months after operation than before operation,lower at 3 months than at 3 days after operation,and lower at 3 months than at3 days and 1 month after operation(P<0.05).The white blood cell level of the middle diameter group was lower than the other two groups at 3 days,1 month and 3 months after the operation(P<0.05).The platelet levels of the three groups of patients were higher at 3 days,1 month and 3 months after operation than before operation,higher at 1 month than 3 days in 1 month after operation,and higher at 3 month than 3 days and 1 month after operation(P<0.05).The platelet levels of the medium diameter group were higher than those of the other two groups at 3 days,1 month and 3 months after operation(P<0.05).There was no significant difference in spleen thickness and subcostal length 3 days after operation in the three groups(P>0.05).The spleen thickness and subcostal length of the three groups of patients were shorter at 1 month than 3days after operation and before operation,and shorter at 3 months than 1 month after operation(P<0.05),the spleen thickness and the subcostal length in the middle diameter group were shorter than those in the other two groups(P<0.05).The total incidence of adverse reactions and complications in the three groups of patients was:the middle diameter group<high diameter group<low diameter group(P<0.05).Conclusion:The use of 300-500μm diameter microspheres for splenic artery embolization has the best effect,with fewer complications and adverse reactions.