8spheres栓塞微球经脾动脉部分栓塞术治疗慢性肝窦阻塞综合征致脾功能亢进的疗效分析

Analysis of the efficacy of partial embolization of 8spheres embolization microspheres through the splenic artery in the treatment of hypersplenism caused by chronic hepatic sinusoidal obstruction syndrome

目的探讨8spheres栓塞微球行脾动脉部分栓塞术治疗慢性肝窦综合征致脾功能亢进的临床疗效与安全性。方法2020年1月至2024年1月间,39例奥沙利铂为基础的全身化疗后慢性肝窦综合征致脾功能亢进的结直肠癌患者,给予8spheres栓塞微球经脾动脉部分栓塞术(partial splenic embolizationPSE)治疗。记录术前、术后7天、术后1个月、术后3个月白细胞、血小板水平,比较治疗前后肝纤维化指数:天冬氨酸转氨酶和血小板比率指数(APRI)、肝纤维化4因子指数(FIB-4),通过CT、MRI、彩超观察脾脏坏死及大小变化情况,记录治疗相关不良反应发生情况。结果39例患者均成功完成了PSE治疗;术后7天、1个月、3个月外周血白细胞、血小板水平较术前明显升高,术后1、3个月脾脏长度、脾脏厚度、脾静脉宽度较术前明显减小,APRI、FIB-4较术前明显下降,术后3月接近正常水平。PSE相关不良反应主要为发热、疼痛、恶心呕吐等,症状较轻微,经内科对症治疗可缓解,未出现脾脓肿等严重并发症发生。结论8spheres栓塞微球经脾动脉部分栓塞术治疗慢性肝窦综合征继发脾功能患者亢进安全有效,可在临床进一步推广应用。

Objective To investigate the clinical efficacy and safety of partial splenic embolization(PSE)using 8spheres embolization microspheres in the treatment of splenic hyperfunction caused by chronic hepatic sinus syndrome.Methods Between January 2020 and January 2024,39 patients with colorectal cancer were defined as splenic hypersplenism caused by chronic hepatic sinus syndrome after oxaliplatin-based systemic chemotherapy.The patients were subsequently underwent PSE using 8spheres embolization microspheres.The levels of white blood cells and platelets before surgery and after 7 days,1 month,and 3 months of surgery were recorded.Liver fibrosis index,aspartate aminotransferase to platelet ratio index(APRI),and fibrosis 4 score(FIB-4)were compared before and after treatment.Spleen necrosis and size changes were observed through CT,MRI or color Doppler ultrasound.The occurrence of treatment-related adverse reactions was also recorded.Results All 39 patients successfully completed PSE treatment.The levels of peripheral blood white blood cells and platelets were significantly increased after 7 days,1 month,and 3 months of surgery compared to preoperative levels.The length and thickness of the spleen,as well as the width of the splenic vein after 1 month and 3 months of surgery were significantly reduced compared to preoperative levels.The liver fibrosis index(APRI and FIB-4)were significantly decreased after 1 month and 3 months of surgery compared to preoperative levels,and all were basically restored and maintained at normal levels compared with before the surgery.The main adverse reactions related to PSE were fever,pain,nausea,vomiting,etc.The symptoms were mild and could be relieved through targeted internal medicine treatment.No serious complications such as splenic abscess occurred.Conclusions PSE using 8spheres embolization microspheres for the treatment of splenic hyperfunction caused by chronic hepatic sinus syndrome is safe and effective.It can be further promoted and applied in clinical practice.