选择性脾动脉栓塞的临床意义

目的：研究和分析对脾动脉不同部位的栓塞治疗不同疾病的临床效果和方法，方法：选择23例患者，肝硬化合并肝癌6例，单纯肝硬化门脉高压食道胃底静脉破裂出血13例，脾功能亢进4例，男19例，女4例，对19例患者采取脾动脉主干栓塞，而后4例患者作部分性脾实质栓塞（即对部分脾段动脉进行栓塞）。结果：13例肝硬化门脉高压食道-胃底静脉曲张破裂出血的患者于脾动脉主干栓塞后，出血立即停止，除1例栓塞1月后再次出血，1例历肾功能衰竭于栓塞术后48h死亡外，其余11例一年内未再次出血；6例肝癌行脾动脉主干栓塞后进行了肝癌的灌注栓塞（TACE）治疗，未发生术后上消化道出血；4例脾亢患者行脾段动脉栓塞后，第3天白细胞及血小板有明显升高，除左上腹疼痛及发热较明显外，无其他并发症，所有栓塞治疗比较安全，结论：通过动脉超选择性插管栓塞术，可以治疗脾亢及门脉高压引起的上消化道大出血，且保留了脾脏功能，所有治疗方法操作简单、安全有效，值得推广运用。

Clinical significance of selective splenic artery emholization

Objective:To study the effect and method of embolization of splenic artery in different location for different diseases.Methods:Twenty three cases were studied,including liver cancer with hepatocirrhosis in 6,esophageal and gastric varices hemorrhage secondary to portal hypertension in 13 and splenic hyperfunctioning in 4.Nineteen cases of 23 were embolized in the trunk of splenic artery,and other 4 cases in the splenic segmntal artery.Results:Esophageal varices hemorrhage in the total 13 cases was stanched immediately following splenic artery embolization.By which one of them bled again at one month,one died of renal failure in 48 hours,and in the remaining 11 cases there was no bleeding wihtin one year.Six cases of liver cancer underwent hepatic arterial chemo embolization following splenic artery embolization,and no upper gastrointestinal hemorrhage occurred postoperatively.In 4 cases of splenic hyperfunctioning leucocytes and platelets increased 3 days after splenic segmental embolization.Conclusion:partial splenic artery embolization with preservation of the spleen function is a simple,safe and effective method for treating splenic hyperfunctioning and upper gastrointestinal hemorrhage secondary to portal hypertension.