部分脾栓塞治疗血吸虫性脾功能亢进17例报告

目的探讨部分脾栓塞治疗血吸虫性脾功能亢进的临床价值。方法对血吸虫性脾功能亢进17例行周围性部分脾栓塞,栓塞剂为医用明胶海绵。结果栓塞范围50% ~75% (平均59 0% )。术后17例随访6 ~29个月,平均16 9月。白细胞计数术后最后一次随访为( 5 74±1 31 )×109 /L,比术前( 2 19±0 73 )×109 /L显著升高(t=11 86,P=0 000);血小板计数术后最后一次随访为(106 18±30 92 )×109 /L,比术前( 31 29±14 09 )×109 /L显著升高(t=8 28,P=0 000)。未出现严重并发症。结论部分脾栓塞治疗血吸虫性脾功能亢进安全、疗效确切,但其远期疗效需进一步观察。     

脾动脉栓塞治疗肝癌伴肝硬化脾功能亢进20例体会

目的探讨脾动脉栓塞对原发性肝癌伴肝硬化脾功能亢进的治疗效果。方法采用常规的Seldinger法做脾动脉栓塞共20例,术前血小板计数1.9×10     

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我院自 1995年 4月至 2 0 0 1年 10月对 3 3例门静脉高压症伴脾功能亢进病人手术前 4～ 7d施行部分脾动脉栓塞术 (PSAE) ,与 156例同期传统的术前准备相比较 ,在改善血细胞减少 ,减少术前及术中用血 ,提高病人手术耐受力等方面 ,均取得了明显效果。现报告如下。1　临床资料1.1　一般资料　男 2 9例 ,女 4例。年龄 2 9～ 78岁 ,平均58 6岁。脾功能亢进病因 :脾静脉栓塞 8例 ,肝炎性肝硬化 19例 ,血吸虫性肝硬化 6例。治疗前血RBC平均 1 6×10 1 2 /L ,WBC平均 2 9× 10 9/L ,BPC平均 4 2× 10 9/L。凝血酶原时间平均 15 5s。脾脏大小…     

部分脾动脉栓塞治疗艾滋病患者脾功能亢进的疗效评价

目的探讨部分脾动脉栓塞术治疗艾滋病毒(HIV)阳性患者肝硬化继发脾功能亢进的临床效果。方法 6例HIV阳性肝硬化继发脾脏功能亢进患者,术前行B超、CT检查,常规行部分脾动脉栓塞术。分别检测患者术前、术后血细胞计数、肝功能以及门静脉血流动力学变化,监测术后并发症情况。结果术前血小板(PLT)、白细胞(WBC)和红细胞(RBC)分别为(58.3±15.0)×10~9/L、(2.24±0.58)×10~9/L和(2.97±0.78)×10~9/L,术后1周PLT、WBC明显升高(P0.05),红细胞变化不明显。术后1周丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)稍有升高,但2周恢复正常,白蛋白(ALB)术后均升高。部分脾动脉栓塞术(PSE)后门静脉内径、血流速度及血流量均较前减低,但差异无统计学意义(P0.05)。所有患者术后均无严重并发症发生。结论部分脾动脉栓塞术治疗HIV阳性肝硬化继发脾功能亢进可减轻患者血细胞减少,短期内肝功能恢复较好,未出现明显并发症。     

远端脾肾分流术后无吻合口梗阻的重度脾功能亢进一例

1 临床资料 患者女,49岁.因远端脾肾分流术(Warren术)后2年、鼻衄齿龈出血2周于2010年6月14日入院.2年前该患者因肝硬化门静脉高压症行Warren术,术前胃镜检查示食管下段重度静脉曲张伴红色征;B超检查示脾脏大小15.5 cm×4.5 cm,血常规检查:WBC 2.4×109/L,Hb 105 g/L,PLT 64×109/L.术后第14天复查血常规:WBC 3.3×109/L,Hb 101 g/L,PLT 72×109/L.本次入院体格检查:皮肤、巩膜无黄染,腹壁无静脉曲张,肝脏未触及,脾脏下极在肋缘下3 cm可触及,移动性浊音阴性.上消化道钡餐造影及胃镜检查示食管下段静脉轻度曲张.B超检查示肝脏大小正常,肝实质回声不均,门静脉内径13 mm,脾脏大小16.6 cm ×4.6 cm,脾静脉内径12 mm,脾肾静脉吻合口通畅,左肾静脉内径13 mm.血常规检查:WBC 1.6×109/L,Hb 112 g/L,PLT 30×109/L.入院诊断:肝硬化门静脉高压症;Warren术后;重度脾功能亢进.患者于6月18日行部分脾动脉栓塞术,先经脾动脉造影显示脾静脉及肾静脉明显增粗,脾肾静脉吻合口通畅,且有造影剂向肾门方向逆流(图1).再经导管向脾下极分支动脉注入明胶海绵颗粒,栓塞50％脾脏.     

脾动脉主干栓塞序贯肝脾微波消融治疗小肝癌并脾功能亢进一例

目的 探讨脾动脉主干栓塞序贯肝脾微波消融治疗小肝癌并脾功能亢进的临床疗效及安全性。方法 回顾性分析1例采取脾动脉主干栓塞序贯肝脾微波消融治疗的小肝癌并脾功能亢进患者,观察肿瘤坏死情况,治疗前后血常规、肝功能、肝总动脉、脾动脉直径及肝、脾体积等指标。结果 序贯治疗过程顺利,患者无严重并发症发生。患者术后PLT及WBC明显上升（术前：PLT 39×10⁹/L,WBC 2.83×10⁹/L;术后：PLT 114×10⁹/L,WBC 6.75×10⁹/L）;患者肝功能明显改善（术前肝功能Child-Pugh评分9分,术后5分）,术后肿瘤完全灭活,脾肝总动脉比值下降（术前：2.1,术后：1.2）,肝体积增加（术前：742 cm³,术后：1 019 cm³）,存活脾脏体积减少（术前：858 cm³,术后：188 cm³）。结论 脾动脉主干栓塞序贯肝脾微波消融可能是治疗小肝癌并脾功能亢进的优选方案,此方案在局部根治小肝癌的同时,可纠正脾功能亢进及脾动脉盗血,并改善患者肝功能;该序贯治疗还可能促进肝再生。     

部分脾动脉栓塞术治疗肝硬化门静脉高压症的临床疗效分析

目的探讨部分脾动脉栓塞术（PSE）治疗肝硬化门静脉高压症的临床疗效。方法选取我院62例肝硬化食管胃底静脉曲张破裂出血和脾功能亢进患者。全组均行PSE,观察手术前后外周血象变化,门静脉、脾静脉管径变化及术后并发症发生情况。结果PSE术后白细胞、血小板计数高于术前（P〈0．05）;门静脉、脾静脉管径较术前缩小（P〈0．05）,全组病例无严重并发症发生。结论PSE治疗肝硬化并脾功能亢进操作简便、创伤较小、疗效稳固,可以抢救和预防再出血,尤适用于高危病重、老年不适于手术治疗者,是值得临床推广和应用的手术方法。     

内镜注射硬化疗法联合部分脾栓塞术治疗门脉高压症的临床疗效

目的对内镜注射硬化疗法(EIS)联合部分脾栓塞(PSE)治疗肝硬化门脉高压的疗效进行评价。方法对我科于2005年2月至2008年11月收治22例食道胃底静脉曲张合并脾功能亢进的门脉高压患者采用内镜硬化剂注射联合部分脾栓塞的治疗进行回顾性分析。术后定期随访和比较术前术后的消化道出血、肝功能评级及外周血象的变化。结果 EIS平均次数1.8次,所有患者均行1次PSE治疗。术后随访5-30个月,无严重并发症出现,未见有再出血,肝功能部分改善,外周血血小板和白细胞计数明显升高(P<0.05)。结论 EIS联合PSE方法对肝硬化所致的食管胃底静脉曲张出血和门脉高压症是安全有效的。     

肝癌切除联全脾切除治疗肝癌全并肝硬化、脾功能亢进

目的探讨肝癌合并肝硬化、脾功能亢进时肝癌切除联合脾切除的意义.方法将204例肝癌合并肝硬化、脾功能亢进患者分为肝癌切除+脾切除组(简称切脾组,n=94)和单纯肝癌切除组(简称不切脾组,n=110),比较两组患者手术后白细胞、血小板、血清总胆红素、免疫功能的变化以及并发症发生和术后5年生存情况.结果 (1)两组患者术前CD4、CD8、CD4/CD8、IL2、IFN-γ、IL-10水平差异无显著性意义.(2)术后2个月,切脾组CD4和CD4/CD8分别为(40.8±4.1)%和(1.8±0.2),高于不切脾组的CD4(33.8±3.6)%和CD4/CD8(1.1±0.3),而切脾组CD8(25.8±3.8)%低于不切脾组CD8(32.9±4.1%),差异均有显著性意义(P＜0.05);切脾组IFN-γ和IL2分别为(102.2±14.8) pg/ml和(98.1±15.5) pg/ml,高于不切脾组的IFN-γ (85.6±14.7) pg/ml和IL2 (77.7±14.2) pg/ml,而切脾组IL10(56.8±10.3)pg/ml低于不切脾组IL-10(72.8±15.4)pg/ml,差异均有显著性意义(P＜0.05).(3)术后14 d,切脾组白细胞和血小板计数分别为(9.1±1.4)×109/L和(310±55)×109/L,明显高于不切脾组的(3.6±1.2)×109/L和(99±36)×109/L,两组差异有显著性意义(P＜0.01).(4)术后第7天,切脾组血清总胆红素为(24±7)μmol/L,低于不切脾组的(37±13)μmol/L,差异有显著性意义(P＜0.05).(5)两组术后并发症发生率分别为15.9%和14.5%,差异无显著性意义.(6)切脾组术后5年累积生存率56.4%,不切脾组为50.9%,差异无显著性意义(P＞0.05);但术后5年无瘤生存率切脾组和不切脾组分别为37.7%和18.9%,差异有显著性意义(P＜0.05).结论对肝细胞肝癌合并肝硬化脾功能亢进患者,行肝癌切除联合脾切除可促进机体T细胞亚群和Th细胞恢复平衡、WBC和PLT计数恢复正常;可减轻术后肝脏胆红素代谢负担,有利于肝功能恢复;术后并发症发生率并不增加,而术后5年无瘤生存率却明显提高;脾切除后对减慢肝硬化的发展和减少术后上消化道大出血的发生可能也有帮助.     

脾动脉分支血管直径比值法计算脾脏栓塞体积百分比的临床应用

目的探讨脾动脉分支血管直径比值法计算脾脏栓塞体积的临床应用价值。方法回顾性分析20例接受部分脾动脉栓塞术治疗的肝硬化合并脾功能亢进患者的资料。根据术中脾动脉的血管造影图像,测量脾动脉分支血管的直径并计算脾脏栓塞体积百分比。对所有患者均于术后1个月行增强CT检查,并基于VR重建图像计算脾脏栓塞体积百分比。观察术后并发症及不良反应情况,于术前3天、术后1周、1个月、3个月检测外周血红细胞、白细胞及血小板,并进行统计学分析。结果部分脾动脉栓塞术中采用脾动脉分支血管直径比值法计算脾脏栓塞体积百分比[(52.15±3.29)%]与术后1个月CT测量栓塞体积百分比[(49.99±6.02)%]差异无统计学意义(t=-1.630,P=0.120)。所有患者术后均出现中度或中度以下左上腹疼痛,并出现恶心、呕吐、发热症状,均经对症治疗后好转。术前3天、术后1周、1个月、3个月外周血外周血红细胞、白细胞及血小板差异均有统计学意义(P均0.001)。结论部分脾动脉栓塞术中应用脾动脉分支血管直径比值法评估脾脏栓塞体积,简便、实时且较为准确,值得临床推广应用。     

Partial splenic embolization in patients with liver cirrhosis and hepatocellular carcinoma: Effects on portal hemodynamics

Partial splenic embolization (PSE) was performed on patients with liver cirrhosis to control hypersplenism and gastroesophageal varices. In this study, we evaluated the effects of PSE on the portal hemodynamics and hepatic function of 17 cirrhotic patients with hepatocellular carcinoma. The mean splenic volume and the peak platelet count increased significantly and the splenic vein pressure decreased significantly after PSE. However, the portal blood flow did not change. Changes in the 15-min retention rate of indocyanine green and the arterial ketone body ratio were not significant, but the redox tolerance index increased from 0.24 ± 0.28 × 10^–2 to 0.59 ± 0.35 × 10^–2. These results suggest that PSE may reduce perioperative risks in cirrhotic patients with hepatocellular carcinoma who are candidates for hepatic resection.     

肝癌伴脾功能亢进的双介入治疗

目的评价联合应用肝动脉灌注化疗栓塞和部分性脾栓塞治疗肝癌伴脾功能亢进的临床价值及意义。方法收集肝癌伴脾亢58例,经导管肝动脉栓塞(TACE)同时行部分性脾栓塞(PSE),观察术前术后血细胞变化情况。结果TACE联合PSE治疗肝癌合并脾亢可明显改善患者外周血象,术后24小时、1周、2周及4周外周血白细胞、红细胞及血小板较栓塞前明显提高。结论对于肝癌合并脾功能亢进患者,在行肝动脉栓塞灌注化疗同时行部分性脾栓塞术,安全可靠,既能有效控制肿瘤发展,又能有效改善患者血象,提高机体免疫力和患者的生活质量。     

Partial Splenic Embolization Versus Splenectomy for the Management of Hypersplenism in Cirrhotic Patients

Background  Hypersplenism occurs in patients with chronic liver disease, and splenectomy is the definitive treatment. However, the operation may be hazardous in patients with poor liver function. In recent years, partial splenic embolization (PSE) has been widely used in patients with hypersplenism and cirrhosis. This study was conducted to assess the safety and efficacy of PSE compared to splenectomy in the management of hypersplenism in cirrhotic patients. Methods  This study comprised 40 patients with hypersplenism secondary to cirrhosis. They were divided into two groups, each including 20 patients. The first group of patients were treated by PSE using polyvinyl alcohol particles to achieve embolization of at least 50% of the distal branches of the splenic artery. Postembolization arteriography and computed tomography were performed to document the extent of devascularization. Patients in the second group were treated by splenectomy with or without devascularization and left gastric ligation according to the presence or absence of esophageal varices. Results  There was marked improvement in platelet and leukocytic counts in both groups, and the counts remained at appropriate levels during the follow-up period. All patients in the first group had problems related to postembolization syndrome that abated by the first week. One patient in the first group died from myocardial infarction. No deaths occurred in the second group. Asymptomatic portal vein thrombosis developed in one patient in the first group that was treated with anticoagulation, and another patient developed splenic abscess treated by splenectomy with a good outcome. In the second group, three patients developed portal vein thrombosis, one of them being readmitted 4 months postoperatively with mesenteric vascular occlusion; that patient underwent a resection anastomosis with good outcome. Conclusions  Partial splenic embolization is an effective therapeutic modality for the treatment of hypersplenism secondary to chronic liver disease. It is a simple, rapid procedure that is easily performed under local anesthesia; and it allows preservation of adequate splenic tissue to safeguard against overwhelming infection.     

Evolving experience with prevention and treatment of splenic artery syndrome after orthotopic liver transplantation

Impaired hepatic arterial perfusion after orthotopic liver transplantation (OLT) may lead to ischemic biliary tract lesions and graft‐loss. Hampered hepatic arterial blood flow is observed in patients with hypersplenism, often described as arterial steal syndrome (ASS). However, arterial and portal perfusions are directly linked via the hepatic arterial buffer response (HABR). Recently, the term ‘splenic artery syndrome’ (SAS) was coined to describe the effect of portal hyperperfusion leading to diminished hepatic arterial blood flow. We retrospectively analyzed 650 transplantations in 585 patients. According to preoperative imaging, 78 patients underwent prophylactic intraoperative ligation of the splenic artery. In case of postoperative SAS, coil‐embolization of the splenic artery was performed. After exclusion of 14 2nd and 3rd retransplantations and 83 procedures with arterial interposition grafts, SAS was diagnosed in 28 of 553 transplantations (5.1%). Twenty‐six patients were treated with coil‐embolization, leading to improved liver function, but requiring postinterventional splenectomy in two patients. Additionally, two patients with SAS underwent splenectomy or retransplantation without preceding embolization. Prophylactic ligation could not prevent SAS entirely (n = 2), but resulted in a significantly lower rate of complications than postoperative coil‐embolization. We recommend prophylactic ligation of the splenic artery for patients at risk of developing SAS. Post‐transplant coil‐embolization of the splenic artery corrected hemodynamic changes of SAS, but was associated with a significant morbidity.     

Comparison of two different percutaneous splenic artery interventions in the treatment of hypersplenism: preliminary report

BACKGROUND: Splenomegaly and hypersplenism occur in patients with chronic liver disease and liver transplant recipients. The traditional treatment for hypersplenism is surgical removal. Percutaneous interventional methods, such as partial splenic embolization, are alternatives to surgery for hypersplenism. This article gives preliminary findings for a new percutaneous technique in which a narrowed stent is placed in the splenic artery. METHODS: The study focused on 10 patients (eight males and two females) who were treated for hypersplenism. Partial splenic embolization was performed in six patients (age range, 1-43 years) who were waiting for liver transplantation, and narrowed stents were placed in four patients (age range, 12-47 years) who had undergone either orthotopic two patients) or heterotopic two patients) liver transplantation. For embolization, the splenic artery was catheterized and polyvinyl alcohol particles were infused to the distal branches, reducing blood flow in the spleen by 40% to 50%. In the other cases, a narrowed stent was deployed to the middle portion of the splenic artery. RESULTS: Hypersplenism was successfully treated in all 10 cases. Compared with partial splenic embolization, placement of narrowed stents was associated with lower frequencies of postintervention fever and pain, shorter hospital stay, and decreased need for antibiotics. In addition to treating hypersplenism, narrowed-stent placement also completely resolved splenic artery steal syndrome in the two patients (orthotopic liver transplant recipients) with this condition. CONCLUSION: Percutaneous placement of a narrowed stent in the splenic artery is a promising new technique for treating hypersplenism and splenic arterial steal syndrome.     

Hypersplenism due to portal hypertension: retrospective evaluation of 17 patients treated by splenic embolization

PurposeThe objective of this retrospective study was to analyze the efficacy and morbidity associated with splenic artery embolization for hypersplenism due to portal hypertension (PHT), as a function of the volume of the splenic parenchyma embolized and the type of PHT (due to intrahepatic block or segmental PHT).Patients and methodsThis study retrospectively included 17 patients with hypersplenism secondary to PHT (intrahepatic block, n = 14; segmental, n = 3) treated by splenic artery embolization. The splenic volume embolized was estimated by computed tomography (CT) one month after embolization. A clinical assessment and platelet count took place at 7 days, 1 month and 6 months after the embolization.ResultsIn the group with PHT due to intrahepatic block, the mean volume of embolized splenic parenchyma was 63% of the initial volume (range: 30–95%). Six months later, the platelet level had increased by an average of 232%. All patients with fewer than 80,000 platelets/mL at 6 months had an embolization volume less than 50%. In the segmental PHT group, the mean volume of the embolized parenchyma was 62% of the initial volume (range: 20–95%), bleeding symptoms had disappeared in all patients, and the platelet level exceeded 80,000/mL. Six patients (6/17, 35%) had complications, two minor and four major: two splenic abscesses, one respiratory distress with ascites, and one pancreatitis with ascites. Five of the six complications were observed in patients with a volume of embolized splenic parenchyma more than 70%.ConclusionOur results show that splenic embolization of more than 50% of the parenchyma is effective in the treatment of hypersplenism due to PHT, but that when the embolized volume exceeds 70%, the procedure is associated with considerable morbidity.     

Giant iatrogenic splenic pseudocyst

Partial splenic arterial embolization was used to treat hypersplenism in a 10-year-old boy with portal hypertension secondary to congenital hepatic fibrosis. After embolization the spleen remained enlarged, but the boy's platelet count increased and his variceal bleeding ceased. One month later, he returned with vomiting and an abdominal mass. Computed tomography showed a large cyst of the spleen with a small rim of residual splenic tissue. Percutaneous drainage with ultrasound guidance yielded 2,800 mL of brown fluid. Wedge-shaped infarctions are described early after splenic embolization, and these areas eventually fibrose and contract. In this case, the embolization resulted in splenic necrosis and liquefaction with pseudocyst formation. This unusual complication was effectively treated without surgery.     

经导管动脉硬化栓塞术治疗Kasabach-Merritt综合征

目的探讨经导管动脉硬化栓塞术治疗Kasabach-Merritt综合征(KMS)的疗效。方法收集经超声、CT、生化检查结合临床表现确诊的KMS患儿58例,纠正血小板减少及凝血功能异常后,给予经导管动脉硬化栓塞术进行治疗。结果对所有患儿均顺利完成经导管动脉硬化栓塞术,术后动脉造影见瘤体基本消失;术后1周血小板[(267.66±61.50)×109/L]和纤维蛋白原[(2.64±0.40)g/L]水平均明显高于术前[血小板:(35.24±12.12)×109/L,纤维蛋白原:(1.47±0.33)g/L],差异有统计学意义(P均0.01);44例患儿接受1次经导管动脉硬化栓塞术、11例接受2次经导管动脉硬化栓塞术、3例接受3次经导管动脉硬化栓塞术;所有患儿均达治愈标准。结论经导管动脉硬化栓塞术治疗KMS安全、有效,值得临床推广应用。     

部分性脾栓塞术在肝癌伴脾功能亢进治疗中的应用

目的评价部分性脾栓塞术（PSE）在原发性肝癌伴脾功能亢进介入治疗中的疗效及临床意义。方法原发性肝癌伴脾功能亢进患者12例，男10例，女2例．平均年龄51．1岁；肝功能Child－PughA级3例，B级9例；在行肝动脉插管化疗栓塞术（TACE）的同时行PSE；术后定期复查血常规和肝功能。结果本组脾栓塞面积为50％～60％，无脾脓肿等严重并发症。术后WBC和PLT显著提高（P〈0．05），并长期维持在较高水平，RBC数量和HG量无明显改变（P〉0．05）。TBIL、ALT和AST无明显变化（P〉0．05），TBA下降（P〈0．05）。结论PSE能纠正脾功能亢进，提高血WBC和PLT的数量，使原发性肝癌伴脾功能亢进患者的TACE能顺利进行，是一种安全、有效的治疗方法。