Will partial splenic embolization followed by splenectomy increase intraoperative bleeding?

BACKGROUND Partial splenic embolization(PSE)has been suggested as an alternative to splenectomy in the treatment of hypersplenism.However,some patients may experience recurrence of hypersplenism after PSE and require splenectomy.Currently,there is a lack of evidence-based medical support regarding whether preoperative PSE followed by splenectomy can reduce the incidence of complications.AIM To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism.METHODS Between January 2010 and December 2021,321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department.Based on whether PSE was performed prior to splenectomy,the patients were divided into two groups:PSE group(n=40)and non-PSE group(n=281).Patient characteristics,postoperative complications,and follow-up data were compared between groups.Propensity score matching(PSM)was conducted,and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding(IB).The receiver operating characteristic curve,Hosmer-Lemeshow goodness-of-fit test,and decision curve analysis(DCA)were employed to evaluate the differentiation,calibration,and clinical performance of the model.RESULTS After PSM,the non-PSE group showed significant reductions in hospital stay,intraoperative blood loss,and operation time(all P=0.00).Multivariate analysis revealed that spleen length,portal vein diameter,splenic vein diameter,and history of PSE were independent predictive factors for IB.A nomogram predictive model of IB was constructed,and DCA demonstrated the clinical utility of this model.Both groups exhibited similar results in terms of overall survival during the follow-up period.CONCLUSION Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.

Transcatheter embolization for hemorrhage from aberrant testicular artery after partial nephrectomy:A case report

BACKGROUND Arterial bleeding typically involves the renal artery following partial nephrectomy;in this study,we present a case of bleeding originating from the testicular artery that has not been reported in previous studies.CASE SUMMARY A 52-year-old man suffered hemorrhage from a perinephric branch of the aberrant left testicular artery after an open nephron-sparing surgery for renal cell carcinoma.Clinical signs of bleeding were manifested by the patient,such as fresh blood drainage from the catheter,decreased hemoglobin levels,and significant vital sign changes.Since computed tomography did not show evidence of active bleeding,transcatheter angiography was conducted to identify the bleeding site.Fluoroscopic spot images confirmed bleeding derived from a perinephric branch of the testicular artery originating from the segmental artery of the left renal artery.Using n-butyl-2-cyanoacrylate,successful transcatheter arterial embolization of the affected branch was performed.Immediately after the embolization procedure,the bleeding ceased,and the patient experienced complete recovery devoid of complications.CONCLUSION In patients with postoperative arterial hemorrhage after partial nephrectomy,the testicular artery can be a rare but notable source of bleeding.Accurate bleeding site localization via angiographic evaluation,followed by transcatheter arterial embolization,can be instrumental for safe,prompt,and effective hemostasis.

Effect of partial splenic embolization on the immune function of cirrhosis patients with hypersplenism

Objective:To discover the effect of partial splenic embolization on the immune function of cirrhotic patients with hypersplenism.Methods:Patients involved in the study were enrolled and divided into three groups,including control group,experimental group,and complication group.Numbers of CD3^+,CD4^+ and CD8^+ T cells and CD4^+CD25^+CDl27^(low/-) Treg cells in the peripheral blood of patients before surgery,1 month,6 months,1 year,and 2 years after surgery were analyzed by fluorescence active cell sorting(FACS).Contents of immunoglobulins(IgA,IgG and IgM) were analyzed by auto immunoassay analyzer.Results:In the peripheral blood of patients from experimental group,numbers of CD3^+,CD4^+ and CD8^+ T cells initially declined,but afterwards increased to normal level;in the peripheral blood of patients from complication group,CD3^+ and CD8^+ T cells showed the same trend,but the number of CD4^+ T cells was below normal level at all detection times.Furthermore,CD3^+,CD4^+ and CD8^+ T cells in the peripheral blood of patients from complication group were initially less than those in experimental group,and afterwards were comparable between two groups.In patients from both experimental group and complication group,the number of CD4^+CD25^+CDl27^(low/-)Treg cells increased 1 month and 6 months after surgery,and gradually restored to normal level.CD4^+CD25^+CDl27^(low/-)Treg cell counts in patients from complication group were initially more than those in patients from experimental group 1 month and 6 months after surgery,but then they were comparable.Furthermore,contents of immunoglobulins(IgA,IgG and IgM) were comparable in three groups at all detection times.Conclusion:Partial splenic embolization influenced the immune function of cirrhotic patients with hypersplenism in the short term but the immune function could afterwards gradually restore to normal.Our results implicated that measures that prevent infection and improve immune function were necessary in early stage after undergoing PSE in order to reduce complications.

Partial splenic artery embolization in cirrhotic patients

Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization(PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in re-gards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications.

Partial embolization as re-treatment of hypersplenism after unsuccessful splenic artery ligation

Ligation of splenic artery(LSA) is used for the treatment of liver cirrhosis with hypersplenism. However, hypersplenism is not significantly improved following LSA treatment in some cases, and there are few reports of retreatment of hypersplenism after LSA. We report the case of a47-year-old man with liver cirrhosis and hypersplenism who underwent LSA treatment, but did not significantly improve. Laboratory tests revealed severe leukocytopeniaand thrombocytopenia. Celiac computed tomography arteriogram and digital subtraction angiography revealed two compensatory arteries connected to the hilar splenic artery from the left gastro-epiploic artery and from the dorsal pancreatic artery. Partial splenic embolization(PSE) was performed through the compensatory arteries. As a result, the patient achieved partial splenic ischemic infarction, and white blood cell and platelet counts rose and remained in the normal range. PSE is an effective therapeutic modality for the retreatment of hypersplenism when other modalities have failed.

Treatment of gastric varices with partial splenic embolization in a patient with portal vein thrombosis and a myeloproliferative disorder

Therapeutic options for gastric variceal bleeding in the presence of extensive portal vein thrombosis associated with a myeloproliferative disorder are limited.We report a case of a young woman who presented with gastric variceal bleeding secondary to extensive splanchnic venous thrombosis due to a Janus kinase 2 mutation associated myeloproliferative disorder that was managed effectively with partial splenic embolization.

Partial splenic embolization in the management of thalassemia major A report of 40 cases

Forty children with thalassemia major were treated with gelfoam particles for partialsplenic embolization (PSE).The embolization of the spleen ranged from 50 to 85 per cent.Af-ter PSE,the spleen shrank greatly,and the symptoms of anemia improved.The immunologicalfunction of the body was the same as before PSE.All patients showed a marked reduction intransfusion requirements.Therefore,it is believed that PSE is an effective therapy for tha-lassemia major.

Partial Splenic Artery Embolization in Cirrhosis Is a Safe and Useful Procedure

Background: Portal Hypertension is a common complication of cirrhosis. It leads to splenomegaly which manifests with features of hypersplenism. This results in leucopenia which increases the likelihood of sepsis and prevents treatment with interferon. Thrombocytopenia increases the risk of bleeding including variceal bleeds which make the anemia worse. This study was done to determine the usefulness and safety of partial splenic artery embolization (PSAE) in portal hypertension due to cirrhosis. Methods: Patients with PSAE were identified by using International Classification of Diseases (ICD)-10 coding from medical records and their charts were reviewed retrospectively. 25 patients underwent splenic artery embolization at The Aga Khan University Hospital Karachi from November 2000 to December 2016. 18 patients who underwent PSAE for disabling hypersplenism caused by cirrhosis were included. Patients who were under 18 year of age, or in whom PSAE were performed for reasons other than cirrhosis and those with missing records/incomplete data were excluded (n = 7). Information was collected regarding demographic details, procedure indications, nature, technique, clinical efficacy, repeat embolization and complications along with laboratory and radiological investigations. Results: Eighteen patients of cirrhosis with a mean age of 43.47 ± 10.926 years, of which 14 were males, underwent PSAE (19 procedures). Indications were severe hypersplenism which precluded treatment with interferon and ribavirin (n = 8) and recurrent Gastro-oesophageal variceal (GOV) bleeds due to advanced Child-Pugh grade and thrombocytopenia (n = 10). Hematological parameters improved significantly following PSAE. Three out of eight patients successfully completed interferon + ribavirin treatment for hepatitis C (HCV) infection post PSAE, and GOV bleeds stopped in eight out of 10 patients. Complications included mild Left upper quadrant (LUQ) abdominal pain n = 9 (47.3%), post-embolization syndrome n = 4 (21%), and clinically insignificant pleural effusion n = 4 (21%). One patient developed spontaneous bacterial peritonitis (SBP) which was appropriately managed. One patient needed re-emobilization after 6 months. Conclusion: PSAE is a safe and effective procedure in the treatment of hypersplenism due to cirrhosis.

Evaluation of the effect of partial splenic embolization on platelet values for liver cirrhosis patients with thrombocytopenia

AIM: To investigate the effect of partial splenic embolization (PSE) on platelet values in liver cirrhosis patients with thrombocytopenia and to determine the effective embolization area for platelet values improvement. METHODS: Blood parameters and liver function indicators were measured on 10 liver cirrhosis patients (6 in Child-Pugh grade A and 4 in grade B) with thrombocytopenia (platelet values < 80 × 103/μL) before embolization. Computed tomography scan was also needed in advance to acquire the splenic baseline. After 2 to 3 d, angiography and splenic embolization were performed. A second computed tomography scan was made to confirm the embolization area after 2 to 3 wk of embolization. The blood parameters of patients were also examined biweekly during the 1 year follow-up period. RESULTS: According to the computed tomography images after partial splenic embolization, we divided all patients into two groups: low (< 30%), and high (≥ 30%) embolization area groups. The platelet values were increased by 3 times compared to baseline levels after 2 wk of embolization in high embolization area group. In addition, there were significant differences in platelet values between low and high embolization area groups. GPT values decreased significantly in all patients after 2 wk of embolization. The improvement in platelet and GPT values still persisted until 1 year after PSE. In addition, 3 of 4 (75%) Child-Pugh grade B patients progressed to grade A after 2 mo of PSE. The complicationrate in < 30% and ≥ 30% embolization area groups was 50% and 100%, respectively. CONCLUSION: Partial splenic embolization is an effective method to improve platelet values and GPT values in liver cirrhosis patients with thrombocytopenia and the ≥ 30% embolization area is meaningful for platelet values improvement. The relationship between the complication rate and embolization area needs further studies.

Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension

AIM To determine the outcomes of partial splenic em-bolization(PSE) for massive splenomegaly due to idiopathic portal hypertension(IPH).METHODS In this prospective study, we evaluated the charac-teristics and prognosis of consecutive patients with IPH who underwent PSE for all indications at a single medical center between June 2009 and January 2015. The inclusion criteria were: presence of hypersplenism, massive splenomegaly, and resultant pancytopenia. The exclusion criteria were: presence of other diseases causing portal hypertension. During the post-PSE period, the patients were hospitalized. All patients underwent abdominal computed tomography imaging 4 wk post-PSE to determine total splenic and non-infarcted splenic volumes.RESULTS A total of 11 patients, with median age of 33.27 ± 4.8 years, were included in the study. Mean spleen size was 22.9 cm(21-28 cm), and severe hypersplenismwas diagnosed in all patients before PSE. Post-PSE, leukocyte and platelet counts increased significantly, reaching peak levels in the second week with gradual decreases thereafter. Liver function tests did not exhibit significant changes during post-intervention follow-up. All patients developed post-embolization syndrome, and one patient experienced serious complications; all complications were successfully treated with conservative therapy and no death occurred. CONCLUSION Our findings showed that PSE has a lower complication rate than previously-reported surgical complication rates, which supports this intervention as a viable alternative for high-risk operable patients with severe hypersplenism.

Combined treatment of hepatocellular carcinoma with partial splenic embolization and transcatheter hepatic arterial chemoembolization

AIM: To prospectively evaluate the effi cacy and safety of partial splenic embolization (PSE) combined with transcatheter hepatic arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma (HCC). METHODS: Fifty patients suffering from primary HCC associated with hypersplenism caused by cirrhosis were randomly assigned to 2 groups: group A receiving PSE combined with TACE (n = 26) and group B receiving TACE alone (n = 24). Follow-up examinations included calculation of peripheral blood cells (leukcytes, platelets and red blood cells) and treatment-associated complications. RESULTS: Prior to treatment, there was no signifi cant difference in sex, age, Child-Pugh grade, tumor diameter, mass pathology type and peripheral blood cell counts between the 2 groups. After treatment, leukocyte and platelet counts were significantly higher in group A during the 3-mo follow-up period (P < 0.05), but lower in group B (P < 0.05). Severe complications occurred in 3 patients (11.5%) of group A and in 19 patients (79.2%) of group B (P < 0.05), and there was no significant difference in symptoms of post-embolization syndrome, including abdominal pain, fever, mild nausea and vomiting between the 2 groups (P > 0.05). CONCLUSION: PSE combined with TACE is more effective and safe than TACE alone for patients with HCC associated with hypersplenism caused by cirrhosis.

Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

一个 66 岁的女人与自发的门静脉高血压(IPH ) 为脾机能亢进经历了部分脾的 embolization (PSE ) 。一个星期以后，提高对比的 CT 揭示了广泛的门静脉血栓(PVT ) 并且扩大了 portosystemic 分流。PVT 没被尿激的静脉内的管理溶解。正确的门静脉是经由在超声的指导和 4 Fr 下面的经皮的 transhepatic 线路的 canulated。直导管通过血栓被推进进门静脉。Transhepatic 指导导管的血栓溶解被执行溶解 PVT， splenorenal 分流并发地被堵塞增加门血流，用堵塞汽球后退 transvenous 涂去(BRTO ) 技术。随后的提高对比的 CT 显示出门静脉和形成血栓 splenorenal 分流的好明显。与 BRTO 相结合的 Transhepatic 指导导管的血栓溶解为有 portosystemic 分流的 PVT 可行、有效。

Expectations for partial splenic arterial embolization simultaneous transcatheter arterial chemoembolization for hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is frequently complicated by cirrhosis,and it is not unusual for treatment options to be limited as a result of pancytopenia due to hypersplenism.Partial splenic embolization(PSE)has been performed for thrombocytopenia resulting from hypersplenism.However,the safety and effi cacy of concurrent transcatheter arterial chemoembolization(TACE)with PSE for HCC remain unclear.Thrombocytopenia has been improved,and treatment continued using concurrent PSE.In addition,the hepatic functional reserve could be maintained even after treatment for HCC.Concurrent TACE and PSE for HCC with thrombocytopenia can be expected to help maintain a hepatic reserve,and it may contribute to improving the prognosis of HCC.Hence,PSE could lead to an asplenic state.The appearance of Howell-Jolly bodies on a peripheral blood smear is reported useful for assessing splenic function.The appearance of Howell-Jolly bodies is associated with an increased risk for post-splenectomy sepsis/overwhelming post-splenectomy infection in patients with reduced splenic function.These bodies are frequently observed in peripheral erythrocytes after PSE,and when they are present,it is appropriate to administer the pneumococcal vaccine to prevent severe infection.The expectations for PSE combined with TACE for the treatment of HCC associated with cirrhosis are reviewed.

Total splenic artery embolization for splenic artery aneurysms in patients with normal spleen

AIM:To evaluate total embolization of the main splenic artery in patients with splenic artery aneurysms(SAAs)and normal spleen.METHODS:Thirty-five consecutive patients with SAAs were referred for treatment with coil embolization.Patients were classified into two groups:coil embolization of the main splenic artery with complete occlusion of the artery and aneurysms(group A,n=16),and coil embolization of the aneurysmal sac with patency of the splenic artery(group B,n=19).Data on white blood cell(WBC)and platelet counts,liver function,and complications were collected on days 7 and 30,and subsequently at a 6-mo interval postoperatively.Abdominal computed tomography was routinely performed to calculate the splenic volume before and 1 mo after the procedure,and subsequently every 6 mo during follow-up.RESULTS:Coil embolization of the SAAs was technically successful in all 35 patients,with no procedurerelated complications.The post-embolization syndrome,including abdominal pain,fever and vomiting,occurred in six patients(37.5%)in group A and three patients in group B(15.8%).There were no significant differences in WBC and platelet counts between preoperatively and at each follow-up point after the procedures.There were also no significant differences in average WBC and platelet counts between the two groups at each follow-up point.There were significant differences in splenic volume in group A between preoperatively and at each follow-up point,and there were also significant differences in splenic volume between the two groups at each follow-up point.CONCLUSION:Total embolization of the main splenic artery was a safe and feasible procedure for patients with SAAs and normal spleen.

脾多肽联合乙酰半胱氨酸对重症肺部感染老年患者的治疗效果分析

目的 探讨脾多肽联合乙酰半胱氨酸对重症肺部感染老年患者的治疗效果。方法 选择2021年1月至2023年12月睢县人民医院接诊的重症肺部感染老年患者86人作为研究对象,依据随机数字表分为对照组(n=43)、观察组(n=43)。两组均接受常规治疗,对照组在此基础上采用乙酰半胱氨酸雾化吸入,观察组采用乙酰半胱氨酸雾化吸入联合脾多肽注射液滴注治疗。对比两组治疗前、后的相关临床指标:肺功能指标(动脉血氧分压、动脉血二氧化碳分压、氧合指数)、呼吸动力参数(气道阻力,峰值吸气压力,平均气道压力)、血清应激指标(血清游离皮质醇,促肾上腺皮质激素)。对比两组的症状持续时间、机械通气时间、治疗效果以及严重不良反应情况。结果 治疗后,观察组动脉血氧分压、氧合指数、峰值吸气压力高于对照组,观察组动脉血二氧化碳分压、气道阻力、平均气道压力、血清游离皮质醇、促肾上腺皮质激素低于对照组,差异均有统计学意义(P <0.05)。观察组发热、咳嗽、呼吸急促的持续时间、机械通气的时间短于对照组,差异均有统计学意义(P <0.05)。观察组治疗效果分级优于对照组,差异具有统计学意义(P <0.05)。两组均未产生严重不良反应。结论 针对重症肺部感染老年患者,在常规治疗措施的基础上,联合使用脾多肽静脉滴注及乙酰半胱氨酸雾化吸入,可以有效改善患者的治疗效果以及多个维度的临床指标,缩短患者的临床症状维持时间长度及使用机械通气时间,具有良好的安全性。

Laparoscopic partial splenectomy for large splenic ~pidermoid cyst

Splenic epidermoid cysts are relatively rare lesions traditionally treated by splenectomy. Concerns about overwhelming postsplenectomy sepsis have led to the development of splenic preservation procedures in the treatment of cystic diseases of the spleen. Better understanding of the splenic segmental anatomy and advances in laparoscopic skills has made laparoscopic partial splenectomy a preferred treatment for splenic cysts while preserving splenic function. We reported a case of a 30-year-old male patient with a large epidermoid splenic cyst managed successfully by laparoscopic partial splenectomy. The patient recovered well after operation and was asymptomatic on a follow-up of 1 year with no recurrence on ultrasonography and a normal platelet count. Laparoscopic partial cystectomy is an acceptable procedure for the treatment of splenic cysts which locate in the pole of spleen. On the one hand, it cures the disease preserving the splenic tissue without risk of bleeding or recurrence; on the other hand, this minimally invasive technique induces a reduced hospital stay and a more rapid recovery.

动脉血二氧化碳分压联合修正版Geneva评分对急性肺栓塞的联合预测效能

目的:探讨动脉血二氧化碳分压(Partial pressure of carbon dioxide,PaCO_(2))联合修正版Geneva评分对急性肺栓塞(Pulmonary embolism,APE)的联合预测效能。方法:回顾性分析2019年1月至2022年12月于我院进行治疗的疑似急性肺栓塞患者的临床资料265例。据计算机断层扫描肺血管造影术(Computed tomography pulmonary angiography,CTPA)检查结果将265例患者分为APE组(CPTA阳性)与Non-APE组(CPTA阴性),其中APE组138例,Non-APE组127例。收集并对比两组患者的临床资料,并分析PaCO_(2)联合修正版Geneva评分的联合预测效能。结果:APE组与Non-APE组患者的呼吸困难、咳血、晕厥、胸痛症状分布差异无统计学意义。APE组患者修正版Geneva评分分布明显高于Non-APE组(P<0.05);APE组PaCO_(2)<35 mmHg的患者明显多于Non-APE组(P<0.05)。PaCO_(2)联合修正版Geneva评分对于急性肺栓塞预测的曲线下面积(Area Under Curve,AUC)、95%CI高于单独指标。结论:PaCO_(2)联合修正版Geneva评分预测急性肺栓塞的曲线下面积显著高于单一指标,其敏感度显著优于单独修正版Geneva评分系统,特异度优于PaCO_(2)。

部分脾动脉栓塞术对比脾切除术治疗肝硬化脾功能亢进的Meta分析

目的系统评价部分脾动脉栓塞术(partial splenic artery embolization,PSE)与脾切除术治疗肝硬化脾功能亢进的疗效。方法通过检索PubMed、Cochrane Library、Embase、中国知网、万方数据知识服务平台等数据库,收集自建库以来至2021年10月30日关于PSE与脾切除术治疗肝硬化脾功能亢进的随机对照试验和队列研究,由两位研究员分别独立筛选文献、提取资料和评价偏倚风险后进行统计分析。结果共纳入14篇文献,1092例患者,Meta分析结果显示,两组术后1周、1个月、1年白细胞计数水平比较,差异均无统计学意义(P>0.05),术后6个月(MD=-2.03,95%CI:-3.03~-1.04,P<0.001)脾切除术组明显高于PSE组;两组术后1个月、1年血小板计数比较,差异无统计学意义(P>0.05);术后1周(MD=-65.46,95%CI:-116.39~-14.52,P=0.01)和术后6个月(MD=-117.99,95%CI:-229.71~-6.27,P=0.04)脾切除术组均高于PSE组;两组术后1周、1个月和1年红细胞计数水平比较,差异均无统计学意义;两组患者NK细胞计数水平比较,术后1个月(MD=6.02,95%CI:4.27~7.77,P<0.001)、术后1年(MD=3.53,95%CI:1.68~5.37,P=0.0002),均提示PSE组的术后自然杀伤细胞计数水平明显高于脾切组;与脾切除术组比较,PSE组术中出血量更少(MD=-73.92,95%CI:-89.39~-58.45,P<0.001)、住院费用更少(MD=-0.80,95%CI:-1.27~-0.34,P=0.0008)、住院时间也更短(MD=-4.08,95%CI:-5.22~-2.95,P<0.001)。结论现有证据表明,PSE治疗肝硬化脾功能亢进短期与远期均有一定的疗效,相较于脾切除术,其手术创伤小,住院时间和费用少,并发症易控制,且可保留一定的免疫功能,更值得在临床应用推广。受纳入文献数量以及质量的限制,上述结论仍需开展更多高质量研究予以验证。

肝动脉化疗栓塞术联合脾部分栓塞术治疗原发性肝癌伴脾功能亢进的临床疗效分析

目的探讨脾部分栓塞术联合肝动脉化疗栓塞术在原发性肝癌伴脾功能亢进中的临床疗效及应用价值。方法80例原发性肝癌伴脾功能亢进患者,采用简单化随机法将所有患者分为对照组和实验组,每组40例。对照组患者实施肝动脉化疗栓塞术,实验组患者在对照组的基础上联合脾部分栓塞术。比较两组患者临床疗效、不良反应发生情况以及手术前后谷丙转氨酶(ALT)、总胆红素(TBIL)、白细胞计数(WBC)、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)。结果实验组治疗总有效率95.0%高于对照组的77.5%,差异具有统计学意义(P<0.05)。实验组患者术前ALT为(55.57±8.56)U/L、TBIL为(24.25±3.12)μmol/L,术后7 d ALT为(33.27±4.08)U/L、TBIL为(17.58±2.15)μmol/L;对照组患者术前ALT为(55.29±8.37)U/L、TBIL为(24.64±3.15)μmol/L,术后7 d ALT为(49.68±6.65)U/L、TBIL为(22.12±2.86)μmol/L。与术前比较,术后7 d两组患者ALT、TBIL水平均有所改善,且与对照组比较,实验组患者的ALT、TBIL水平改善效果更明显,均恢复至正常水平,差异具有统计学意义(P<0.05)。实验组患者术前WBC为(2.48±0.26)×10^(9)/L、PLT为(64.36±10.15)×10^(9)/L,术后7 d WBC为(6.57±1.18)×10^(9)/L、PLT为(117.38±18.15)×10^(9)/L;对照组患者术前WBC为(2.39±0.18)×10^(9)/L、PLT为(64.51±10.22)×10^(9)/L,术后7dWBC为(3.68±0.53)×10^(9)/L、PLT为(83.16±12.86)×10^(9)/L。与术前比较,术后7 d两组患者的WBC、PLT水平均有所升高,且与对照组比较,实验组患者的WBC、PLT水平升高幅度更明显,均恢复至正常水平,差异具有统计学意义(P<0.05)。实验组患者术前PT为(19.26±2.24)s、APTT为(54.35±8.12)s,术后7 d PT为(10.27±1.88)s、APTT为(31.63±4.15)s;对照组患者术前PT为(19.29±2.26)s、APTT为(54.26±8.10)s,术后7 d PT为(16.56±2.05)s、APTT为(44.32±6.86)s。与术前比较,术后7 d两组患者的PT、APTT均有所缩短,且与对照组比较,实验组患者PT、APTT缩短幅度更明显,均恢复至正常水平,差异具有统计学意义(P<0.05)。两组患者术中、术后均未出现严重不良反应,实验组不良反应发生率7.5%低于对照组的27.5%(P<0.05)。结论肝动脉化疗栓塞术联合脾部分栓塞术能够有效改善原发性肝癌伴脾功能亢进患者的肝功能、血常规,促进患者的凝血功能恢复,且安全性良好,值得临床推广应用。

Effect of spleen operation on antiviral treatment in hepatitis Cvirus-related cirrhotic patients

AIM:To investigate the impact of spleen operation(SO) on interferon-α(IFN-α)-based antiviral treatment in patients with hepatitis C virus(HCV)-related cirrhosis.METHODS:Studies were systematically identified by searching electronic databases including MEDLINE,Cochrane Library,Elsevier,and Embase up to September 30,2013,and relevant clinical studies were reviewed.Sustained virological response(SVR) rate and adherence to therapy were taken as the endpoints of interest.RESULTS:A total of 603 patients from 16 studies were included in the systematic review.Of 372 patients who underwent SO followed by antiviral treatment,the total SVR rate was 39.5%.SVR was associated with HCV genotypes 2/3(OR = 10.84; 95%CI:5.47-21.47; P < 0.00001).IFN-α dose needed to be reduced in 29.4%,and IFN-α-based therapy was discontinued in 11.5% of patients.Analysis of controlled studies showed that SVRs were achieved in 34.1% of patients with SO and 31.1% of patients without SO.SO had no effect on the SVR rate in cirrhotic patients with genotype 1 HCV infection(OR = 1.28; 95%CI:0.51-3.22; P = 0.60),but improved the SVR rate in patients with genotypes 2/3 infection,though the difference was not significant(OR = 0.36; 95%CI:0.13-1.02; P = 0.05).CONCLUSION:SO combined with IFN-α-based antiviral therapy may be suitable in cirrhotic patients with genotypes 2/3 HCV infection,but not in those with genotype 1 infection.