近端与远端脾动脉栓塞治疗肝硬化脾功能亢进的临床对比研究

Clinical comparative study of proximal and distal splenic artery embolization in the treatment of hypersplenism due to cirrhosis

目的对比评价两种不同脾功能亢进介入治疗方法的临床疗效及不良反应,以选择更适合的介入治疗方法。方法回顾性分析从2019年1月~2021年12月接受脾动脉栓塞术的68例患者,根据不同方案分为两组,A组21例近端脾动脉栓塞,B组47例远端脾动脉栓塞。评价两者的技术成功率,比较两组术后不同时段外周血、肝功能动态变化、脾脏体积变化以及不良反应。结果两种术式的技术成功率均为100%。两组术后不同时段血小板(PLT)和白细胞(WBC)计数均较术前明显升高(P<0.05),且A组术后第6个月PLT计数较B组升高更显著(P<0.05)。B组术后1周肝功能指标丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)较术前升高(P<0.05)。两组患者术后均未出现严重不良反应。B组患者发热、疼痛发生率明显高于A组(P<0.05)。两组患者术后第6个月复查腹部CT,两组术后脾脏体积较术前明显缩小(P<0.05),两组之间脾脏体积缩小的差异无统计学意义(P>0.05)。结论两种技术的临床疗效确切,近端脾动脉栓塞较远端脾动脉栓塞有更好的长期疗效与更轻的不良反应。

Objective To compare two different interventional treatment methods for hypersplenism.Methods Sixty-eight patients underwent proximal(21)or distal(47)splenic artery embolization(SAE)from January 2019 to December 2021.The post-SAE changes of peripheral blood cell counts,liver functions,spleen volumes,and adverse reactions were compared between the two proximal and distal SAE groups.Results The SAE was successful in all patients.Platelet(PLT)and white blood cell(WBC)counts in both groups were significantly increased after SAE(P<0.05).The increase of PLT count 6 months after proximal SAE was significantly greater than that of distal SAE(P<0.05).Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were significantly increased 1-week after distal SAE(P<0.05).There were no serious adverse reactions in both groups.The incidence of fever and pain in distal SAE was significantly higher than that in proximal SAE(P<0.05).Abdominal CT at 6 months after SAE showed significant spleen volume reduction in both groups(P<0.05)without statistical significance between the two groups(P>0.05).Conclusion Both proximal and distal SAE have excellent clinical efficacy with better long-term effects and less adverse reactions in proximal SAE.