部分脾栓塞对脾功能亢进患者血常规与脾静脉血流动力学的影响

Effect of Partial Splenic Embolization on Blood Routine and Splenic Venous Hemodynamics in Patients with Hypersplenism

目的探讨部分脾栓塞对脾功能亢进患者血常规与脾静脉血流动力学的影响。方法选取我院自2013年8月至2015年5月收治的56例脾功能亢进患者作为研究对象,均采用部分脾栓塞术治疗,按栓塞程度分组,比较不同栓塞体积患者术前、术后血小板(PLT)、白细胞(WBC)、血红蛋白(Hb)的变化,监测术前、术后患者脾静脉血流动力学的变化,统计并发症。结果 1栓塞程度为75%~85%组术后1、2个月WBC、PLT、Hb计数水平最高,与栓塞程度<50%、栓塞程度50%~74%两组对比差异有统计学意义(P<0.05),而栓塞程度50%~74%组上述指标均高于栓塞程度<50%组(P<0.05);2栓塞程度为75%~85%组术后2个月脾静脉内径缩小,血流速、流量降低最明显,与栓塞程度<50%、50%~74%两组对比差异有统计学意义(P<0.05);3栓塞程度<50%组,腹水、出血、血栓形成发生率高于栓塞程度为75%~85%组(P<0.05),三组其余各并发症发生率对比差异无统计学意义(P>0.05)。结论采用部分脾栓塞术治疗脾功能亢进,可优化患者WBC、PLT、Hb水平,改善患者脾静脉高压状态,减少出血事件发生率,其中以75%~85%栓塞体积疗效最显著。

Objective To explore the effect of partial splenic embolization on blood routine and splenic venous hemodynamics in patients with hypersplenism. Methods 56 cases of patients with hypersplenism who were treated in our hospital between August 2013 and May 2015 were selected as the study objects. All patients underwent partial splenic embolization. According to the degree of embolization,the patients were grouped. The changes of preoperative and postoperative platelet( PLT),white blood cell( WBC) and hemoglobin( Hb) were compared between patients with different embolization volume. The changes of splenic venous hemodynamic parameters before and after operation were monitored. The complications were statistically analyzed. Results 1The levels of WBC,PLT and Hb count in 75%-85% of embolization degree group were the highest. Compared with those in embolization degree < 50% group and 50%-74% embolization degree group,there were significant differences( P < 0. 05) while the indexes mentioned above in the 50%-74% embolization degree group were higher than those in the embolization degree < 50% group( P < 0. 05); 22 months after operation,the decrease of splenic venous inner diameter,decline of blood flow velocity and volume in 75%-85% of embolization degree group were the most significantly. There were statistical differences between embolization degree < 50% group and the 50%-74% of embolization degree group( P < 0. 05); 3In the embolization degree < 50% group,the incidence rates of ascites,hemorrhage and thrombosis were higher than those in the75%-85% of embolization degree group( P < 0. 05). There was no significant difference in the incidence of other complications between the three groups. Conclusion To adopt partial splenic embolization in the treatment of hypersplenism can optimize WBC,PLT and Hb levels in patients,improve splenic venous high pressure state and reduce the incidence of complications. The curative effect of 75%-85% of embolization volume is the most significant.