不同类型栓塞剂在脾功能亢进治疗中的应用研究

Study on the application of different embolization agents in the treatment of hypersplenism

[目的]探讨不同粒径微球及明胶海绵行部分脾栓塞术治疗肝硬化脾功能亢进患者的疗效及不良反应。[方法]将60例脾功能亢进患者按术中运用栓塞材料的不同分为3组,分别为300~500μm微球组、500~700μm微球组、明胶海绵组。比较各组术前及术后3 d、7 d、1个月、3个月、6个月外周血白细胞计数、血小板计数及术后不良反应。[结果]各组患者术后白细胞及血小板计数均明显高于术前(P<0.05)。术后3 d、7 d和1个月,300~500μm微球组和500~700μm微球组的白细胞和血小板明显高于明胶海绵组(P<0.05),但300~500μm微球组与500~700μm微球组比较差异无统计学意义(P>0.05)。术后3个月和6个月,300~500μm微球组的白细胞和血小板明显高于500~700μm微球组和明胶海绵组(P<0.05)。300~500μm微球组、500~700μm微球组术后疼痛、发热、恶心、呕吐程度明显轻于明胶海绵组(P<0.05)。[结论]300~500μm微球在部分脾栓塞术中的应用能较好地提高白细胞和血小板的水平,并能长期维持,且不良反应相对较轻。

[Objective]To investigate the efficacy and adverse reaction of partial splenic embolization(PSE)using Embosphere microspheres with different diameter and gelatin sponge in the treatment of hypersplenism in patients with liver cirrhosis.[Methods]Sixty patients with hypersplenism were divided into three groups and treated with 300-500μm,500-700μm Embosphere microspheres and gelatin sponge respectively.The peripheral blood leukocyte count,platelet count and postoperative adverse reactions were compared before treatment and 3 days,7 days,1 month,3 months and 6 months after PSE.[Results]The leukocyte and platelet counts in the three groups were significantly higher after PSE than that before PSE(P<0.05).The leukocytes and platelets in 300-500μm and 500-700μm microspheres groups were significantly higher than that in gelatin sponge group at 3 days,7 days and 1 month after PSE(P<0.05),but there was no significant difference between 300-500μm and 500-700μm microspheres groups(P>0.05).The leukocytes and platelets in 300-500μm microsphere group were significantly higher than that in 500-700μm microsphere and gelatin sponge groups at 3 months and 6 months after PSE(P<0.05).The degree of postembolization pain,fever,nausea and vomiting in 300-500μm and 500-700μm microspheres group and microsphere group was significantly slighter than that in gelatin sponge group(P<0.05).[Conclusion]The application of 300-500μm Embosphere microsphere in PSE can better improve the levels of leukocytes and platelets and maintain for a long time.In addition,the adverse reactions after PSE with 300-500μm microsphere are relatively mild.