介入疗法治疗肝硬化脾功能亢进36例疗效分析

随着介入诊疗技术的发展，应用部分性脾动脉栓塞术(PSE)治疗各种因素引起的脾功能亢进(脾亢)在临床上已逐步开展。2000年以来我们用PSE治疗肝硬化门脉高压并脾功能亢进36例，现将临床疗效分析如下。     

双介入治疗肝硬化门脉高压和脾功能亢进症

目的 探讨经颈内静脉肝内门体分流术(Transjugular intrahepatic portosystemic shunt,TIPS)和部分脾栓塞术(Partial splenic embolization,PSE)联合治疗肝硬化门脉高压及脾功能亢进症的疗效.方法 30例均为肝硬化门脉高压及脾功能亢进症患者,行TIPS术后再行PSE术.用超声检测门、脾静脉内径、门脉主干血流速度、脾脏长径和厚度;血细胞分析仪检测血象.结果 30例患者TIPS术后的门脉压力较术前降低(P＜0.01).门、脾静脉内径较术前缩小(P＜0.01),门脉主干血流速度较术前增快(P＜0.01);术后3～6月的脾脏长径及厚度、白细胞、血小板及血红蛋白较术前均无明显变化(P＞0.05).30例患者PSE术后的门、脾静脉内径、门脉主干血流速度与TIPS术后的比较无明显变化(P＞0,05);而白细胞、血小板及血红蛋白较TIPS术后明显升高(P＜0.01),脾脏长径和厚度较TIPS术后缩小(P＜0.05).结论 联合TIPS和PSE术治疗,能有效降低肝硬化患者的门脉压力,同时又能缓解脾功能亢进.     

部分脾栓塞术(PSE)治疗肝硬化脾功能亢进的研究(摘要)

本文报告用部分脾栓塞术替代外科切脾术治疗16例肝硬化脾功能亢进的病人,以达到纠正脾亢,降低门脉压,改善肝功能,又不影响机体免疫功能的目的. 16例肝硬化均经肝组织活检证实,PSE前有脾肿大(B超示脾面积110.5±32cm~2),外周血象及骨髓象均提示脾功能亢进.经皮股动脉穿刺,将自制双螺旋导管超选择插入脾动脉,经导管注入一定数量的明胶海棉小粒至脾动脉的3～4级分支,PSE前后分别作脾动脉造影,伴门脉高压者经股静脉插管测定WHVP.     

部分脾动脉栓塞术治疗肝硬化门脉高压症10例

[目的]观察部分脾动脉栓塞术(PSE)治疗肝硬化门脉高压症的临床疗效。[方法]对10例肝硬化食管胃底静脉曲张破裂出血和脾功能亢进患者行PSE,观察术前、术后外周血细胞计数,门静脉、脾静脉管径的变化及术后并发症。[结果]PSE术后白细胞、血小板高于术前(P<0.01),红细胞升高(P<0.05),脾亢纠正;门静脉、脾静脉管径较术前缩小(P<0.05),再出血发生减少。[结论]PSE治疗肝硬化并脾功能亢进及食管胃底静脉曲张破裂出血是一种操作简便、创伤小、结果可靠的抢救和预防再出血的方法。     

部分性脾栓塞治疗肝硬化脾功能亢进的临床分析

目的：探讨部分性脾栓塞术(PSE)治疗肝硬化脾功能亢进的临床价值及并发症。方法：14例肝硬化脾亢患者，均行PSE术。结果：10例患者脾亢缓解，外周血白细胞及血小板升至正常。最常见的并发症是腹痛，发热。14例中3例并发胸腔积液，1例同时并发脾脓肿和胸腔积液，1例并发腹水。结论：PSE术能有效地缓解脾亢，但应注意有严重并发症发生的可能。     

部分脾栓塞缓解门脉高压脾亢及胃底食管静脉曲张

目的 探讨部分脾动脉栓塞对缓解门脉高压并脾亢及胃底食管静脉曲张的临床疗效。方法 采用Seldinger技术经股动脉穿刺插管，超选择性脾动脉栓塞治疗肝硬化门脉高压并脾亢及胃底食管静脉曲张46例。观察治疗前后门脉压力，血液白细胞、血小板计数，肝功能及胃底食管静脉曲张的变化情况，判断其治疗效果。结果 栓塞范围为40％～90％，术后患者门脉压力明显降低，肝功能GPT下降，外周血象明显改善，血液白细胞和血小板计数升高，胃底食管静脉曲张得到缓解，上消化道再出血间期延长。无严重的并发症发生。结论 部分脾栓塞治疗肝硬化门脉高压并脾功能亢进是一种安全、有效的方法。既可以降低门脉压力，又可以减轻脾功能亢进，缓解胃底食管静脉曲张。     

部分脾动脉栓塞治疗肝硬化脾功能亢进的作用机制

脾功能亢进(脾亢)是由肝硬化、门静脉高压引起的常见并发症，目前临床治疗脾亢的主要方式是脾切除和部分脾动脉栓塞(PSE)。脾切除治疗脾亢效果确切，可显著改善脾亢患者临床症状。相比于脾切除，部分脾动脉栓塞通过栓塞脾动脉分支使部分脾实质梗死，能够达到与部分脾切除术相似的临床疗效，并保留脾脏及脾脏自身功能。虽然PSE是治疗脾亢的有效方法，但是目前国内外关于PSE对肝纤维化、免疫及肝再生影响的研究报道并不多。本文总结了脾亢发生的常见病因、PSE治疗脾亢机制、不同栓塞方法和材料的治疗效果，以及PSE对肝纤维化、免疫及肝再生的影响，为临床脾亢治疗提供理论依据和新的思路。     

食管胃底静脉栓塞术联合部分脾栓塞术治疗门静脉高压症疗效观察

门静脉高压症是肝硬化的首要并发症，它发生于肝硬化之前，且贯穿于肝硬化始终。它是肝硬化最主要的病理生理变化，常并发消化道出血、脾功能亢进等并发症。其中胃食管曲张静脉破裂出血是门静脉高压症患者的主要死亡原因之一。目前所有的诸多治疗门静脉高压症的方法各有利弊，疗效尚不令人满意，本研究应用双介入术即食管胃底曲张静脉栓塞术(PTVE)联合部分脾栓塞术(PSE)治疗肝硬化门脉高压症所致胃食管曲张静脉破裂出血和脾功能亢进，     

部分性脾动脉栓塞术122例术后并发症原因分析及其防治

脾功能亢进(简称“脾亢”)是由一种或多种病因导致的脾功能过度增强而不适当地隔离和破坏血液成分引起的一组症状。由于外科脾切除术使机体免疫功能下降,易并发感染和出血,随着介入医学的发展及其在临床的广泛应用,部分性脾动脉栓塞术(partial splenic embolizationPSE)成为一种临床广泛接受的“功能性脾切除”的方法以治疗脾功能亢进[1]。PSE具有纠正脾功能亢进降低门脉高压的作用,但术后并发症常见。本文总结我院122例患者的临床资料,对其并发症发生的原因及其处理方法进行讨论,以期预防或减少术后并发症。1资料及方法1·1一般资料本组…     

部分脾栓塞治疗肝硬化脾功能亢进患者36例

肝炎引起的肝硬化脾大、脾功能亢进临床常见,脾功能亢进是以脾脏肿大,外周血细胞减少为特征的临床症候群,严重影响患者的生存期限与生活质量。1979年,Spigos等应用明胶海绵颗粒作部分性脾动脉栓塞法（PSE）明显减少了全脾栓塞所致的并发症。我院2001年6月至2007年6月应用PSE治疗肝硬化门脉高压引起的脾肿大脾功能亢进36例,现报告如下。     

Complications of Partial Splenic Embolization in Cirrhotic Patients

In recent years, partial splenic embolization (PSE) has been widely used in patients with cirrhosis and hypersplenism caused by portal hypertension. We investigated the complications associated with PSE cases seen in our hospital. Seventeen cases of liver cirrhosis that had undergone PSE were examined to investigate the complications associated with it. Mean infarcted area of the spleen was 66.2%. Leukocyte and platelet counts in 16 of 17 patients were seen to improve after PSE and persisted for at least one year. The most frequent side effects were abdominal pain (82.4%) and fever (94.1%). Severe side effects were seen in two of those 17 patients. One patient died from acute on chronic liver failure. The other patients contracted bacterial peritonitis and splenic abscess and needed drainage of splenic abscess before recovery. These two cases were in Child-Pugh class B. In conclusions, PSE is a useful treatment for patients with cirrhosis and hypersplenism caused by portal hypertension. However, the possibility of severe complications, especially in patients with noncompensated cirrhosis, should be kept in mind.     

脾动脉栓塞治疗肝硬化继发脾脏功能亢进的临床效果观察

目的 探讨脾动脉栓塞术（PSE）治疗肝硬化继发脾脏功能亢进的临床效果.方法 选取我院肝硬化继发脾脏功能亢进患者80例,其中研究组48例,行脾动脉栓塞术;对照组32例,行脾脏切除术,比较两组患者的出血量、住院时间、术后恢复、并发症等.结果 与对照组比较,研究组患者的住院时间缩短、出血量减少,差异有统计学意义（P＜0.05）;两组患者术后不良反应比较,差异无统计学意义（P ＞0.05）;PSE后脾局部梗死后门静脉内径减小,与对照组比较差异无统计学意义（P＞0.05）.结论 PSE治疗肝硬化继发脾脏功能亢进临床效果显著,微创易恢复,门静脉宽度变窄,门脉压力降低.     

部分脾栓塞治疗肝硬化门脉高压及脾亢

目的 进一步观察部分脾栓塞治疗肝硬化门静脉高压及脾功能亢进（简称脾亢）的应用价值。方法 经下腔动脉插管对部分脾动脉用明胶海绵颗粒进行栓塞,观察其治疗作用。结果 本文２２例术后外周血白细胞和血小板计数均回升,其中１９例恢复至正常水平,３例部分缓解,门静脉及脾静脉回缩,食道静脉曲张程度改善,凝血酶原时间（ＰＴ）缩短,凝血酶原活动度（ＰＴＡ）增加,脑病发作次数减少,血氨水平下降,未出现严重并发症。结论     

部分脾动脉栓塞术对肝硬化门静脉高压症血流动力学的影响

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及应用价值。方法 23例不同原因肝硬化门静脉高压患者行PSE治疗,PSE术前及术后1周、1、3、6个月彩色多普勒分别检测患者门静脉和脾静脉的内径、血流速度,计算血流量,并与PSE术前配对分析。结果术后各期患者脾静脉、门静脉血流速度及血流量较术前降低（P〈0.05）;脾静脉内径术后各期与术前相比明显缩小（P〈0.05）;而门静脉主干内径术后6个月内缩小不明显（P〉0.05）。结论 PSE能有效的降低门静脉压力。     

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.     

Partial splenic embolization as pretreatment for antiviral therapy in hepatitis C virus infection

Chronic hepatitis C virus infection is frequently complicated by cirrhosis and hypersplenism, which together with several other factors, such as reduced thrombopoietin synthesis in the liver, cause cytopenia. The antiviral combination therapy with pegylated interferon and ribavirin itself is impaired by haematological toxicity. Partial splenic embolization (PSE) by the injection of microspheres via a catheter comprising approximately 30-70% of the splenic parenchyma is now a safe method, which significantly reduces the cytopenia induced by hypersplenism, especially thrombocytopenia. The effect is long lasting up to 20 years and has been documented in a variety of disorders. PSE is now carefully described in a combination modality as a pretreatment to reduce cytopenia in hepatitis C virus-induced cirrhosis patients with hypersplenism, making antiviral therapy possible per se at higher dosages with a sustained duration.     

Bleeding portal-hypertensive gastropathy managed successfully by partial splenic embolization

The use of partial splenic embolization to decrease portal pressure and reduce gastric bleeding from portal-hypertensive gastropathy, a complication of liver cirrhosis, is described. A 62-year-old man with hepatic cirrhosis secondary to hepatitis C and documented portal hypertension was admitted with hypersplenism and bleeding esophageal varices. Endoscopic ligation successfully controlled acute bleeding, but blood loss continued over the next 45 days. Bleeding secondary to portal-hypertensive gastropathy was diagnosed endoscopically. The patient's poor surgical status precluded a portosystemic shunt procedure, so partial splenic embolization was performed radiologically by the injection of Gelfoam squares. Splenic volume decreased 50% following partial embolization. Over 3 weeks, the hemoglobin concentration increased from 8.5 g/dL to 9.8 g/dL, and the platelet count increased from 41,000 to 90,000/microL. Repeat endoscopy found no gastric bleeding 18 days post-procedure. Partial splenic embolization is a radiologic procedure which can be performed safely in patients too ill to undergo portosystemic shunt. This report documents its successful use to manage hypersplenism and reduce portal pressure in a cirrhotic patient with portal-hypertensive gastropathy and hypersplenism.     

部分脾栓塞治疗门脉高压性脾功能亢进的临床研究

目的:研究部分脾栓塞治疗门静脉高压性脾功能亢进的临床意义。方法:采用Seldinger技术经股动脉插入导管至脾动脉,对15例门静脉高压、脾功能亢进患者应用40％碘化油、明胶海绵颗粒及明胶海绵条行脾脏50％～70％栓塞治疗。结果:术后3个月,脾脏明显缩小,白细胞和血小板明显回升,凝血酶原时间缩短,B超下显示门静脉、脾静脉及脾动脉缩小,随访2年患者无食道静脉曲张破裂出血及腹水出现。结论:该方法近期疗效肯定,安全、微创,适合临床普及推广。     

Partial splenic embolization in patients with cirrhosis: efficacy, tolerance and long-term outcome in 32 patients

BACKGROUND: Although partial splenic embolization (PSE) has been proposed in patients with cirrhosis in cases when thrombocytopenia or neutropenia may cause clinical manifestations or if there are contra-indications to other therapeutic procedures, there are limited data on long-term outcome. We provide a retrospective review of results and the tolerance of all PSE procedures in patients with cirrhosis in our department. PATIENTS AND METHODS: Thirty-two consecutive patients with cirrhosis were included over a 6 year period. Indications for PSE were as follows: (1) severe cytopenia preventing necessary antiviral treatment (n=14), percutaneous destruction of hepatocellular carcinoma (n=8) or major surgery (n=3), severe purpura (n=3); (2) painful splenomegaly (n=4). After superselective catheterization, embolization was performed with up to 50% reduction of splenic blood flow. RESULTS: Thrombocyte and leucocyte counts increased markedly (185% and 51% at 1 month; 95% and 30% at 6 months). Thirty-one and 20 patients had platelet count >80,000/mm3 at months 1 and 6 vs only one before PSE. Overall, the aim of PSE was achieved in 27 patients (84%) (planned treatment: 20/25; disappearance of purpura and splenic pain: 7/7). Severe complications occurred in five patients (16%): transient ascites (n=2), splenic and/or portal vein thrombosis (n=2) that resolved after anticoagulation therapy, and splenic abscess (n=2) leading to death. These two patients had splenic necrosis >70%. CONCLUSION: In patients with cirrhosis, PSE may resolve cytopenia and the clinical complications related to hypersplenism or splenomegaly. However, due to a high risk of severe complications, particularly splenic abscess, the indications of PSE should be very limited and the extent of necrosis should be strictly controlled during the PSE procedure.