部分脾动脉栓塞术治疗肝炎肝硬化脾功能亢进症36例临床分析

目的探讨部分脾动脉栓塞术(PSE)治疗肝炎肝硬化并发脾功能亢进及门静脉高压症的疗效和安全性。方法采用Seldinger技术用明胶海绵进行超选择性脾动脉栓塞治疗36例肝炎肝硬化并脾功能亢进患者,观察术前及术后各时段血象、脾脏大小、门静脉宽度变化。结果术后白细胞及血小板明显上升,3个月后稳定在正常水平,术前及术后红细胞无明显变化,3个月后脾脏明显缩小,门静脉宽度也不同程度缩小,术后无严重并发症发生。结论PSE治疗肝炎肝硬化并发脾功能亢进症疗效肯定,安全性高,并能降低门静脉压力,从而预防上消化道出血。     

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。     

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     

脾叶动脉栓塞法治疗脾功能亢进症(附38例报告)

应用经高温高压处理过的明胶海绵粉末与碘化油的混合剂栓塞脾下叶或中叶动脉,治疗脾功能亢进,术后1个月行B超或CT检查,计算脾脏栓塞体积,并行X线钡餐造影或胃镜检查。结果术后患者外周血白细胞、血小板均明显高于术前（P〈0.05）,脾栓塞范围35%~50%;食管胃底静脉曲张不同程度地减轻;无脾脓肿、胸水和肺感染发生;认为超选择栓塞脾下叶或中叶动脉治疗脾功能亢进,安全、有效。     

部分脾动脉栓塞治疗脾功能亢进的疗效

脾功能亢进简称脾亢,其主要临床特征是各种原因造成的脾脏肿大伴血细胞过多消耗,引起患者出现各种相应的临床表现〔1〕。因此,脾功能亢进并非单一疾病,而是一种临床综合征。脾脏增大、门静脉出现高压、血细胞及血小板显著减少,引起严重出血事件的发生,尤其是消化道出血,严重者危及患者生命,因此对于这类患者积极进行干预具有非常重要的临床意义〔2〕。尽管对原发疾病进行有效干预可显著改善患者症状,但是对于增大的脾脏并不具有多大的意义。脾动脉栓塞术是近年来广泛应用于临床上治疗脾功能亢进的有效手段,其可以显著降低门静脉压力,进而增加肝动脉的血液供应,减少由于脾亢引起的血液有效成分的减少〔3,4〕。本研究旨在探讨部分脾动脉栓塞治疗脾功能亢进的临床疗效。     

肝动脉及部分脾动脉栓塞治疗肝癌伴脾功能亢进

目的 观察采用肝动脉栓塞化疗联合部分脾动脉栓塞治疗原发性肝癌合并脾功能亢进的疗效。方法 原发性肝癌伴肝硬化脾功能亢进患者３４例,采用经皮穿刺肝动脉插管化疗栓塞及脾动脉部分栓塞治疗,治疗前后测肝功,免疫指标,外周血及Ｂ超,ＣＴ等。结果 术后ＣＴ随访显示肝脏瘤体缩小２４例,占７０．５８％,其中缩小５０％以上占１３例,２例治疗后行二期手术切除;脾脏栓塞后ＣＴ复查缩小最大３４．７％,最小２０．６％,治疗后     

肝动脉及部分脾动脉栓塞治疗肝癌伴脾功能亢进

目的：临床采用肝动脉栓塞化疗联合部分脾动脉栓治疗原发性肝癌合并脾功能亢进的效。方法：住院原了肝癌伴肝硬化脾功能亢进患者３４例,采用经皮穿刺肝动脉插管化疗栓塞及脾动脉部分栓塞治疗。治疗前后行检测肝功能、指标、外周血及Ｂ超、ＣＴ等。结果：术后ＣＴ随访显示肝脏瘤体缩小２４例,占７０．５８％（２４／３４）,其中缩小５０％以上者１３例,２例治疗后肝功能行二期抹切除;脾脏栓塞后ＣＴ复查缩小,最多３４．７％,最     

内镜套扎-部分脾栓塞联合术治疗门脉高压症的临床疗效观察

探讨内镜套扎-部分脾栓塞联合术治疗门脉高压症的临床应用价值。对2 5例合并食道静脉曲张和脾功能亢进的门脉高压患者进行内镜套扎-部分脾栓塞联合术,对其术前术后外周血象、脾脏大小、门静脉、脾静脉内径的变化进行对比研究。联合术后患者食道静脉曲张得到根治,脾功能亢进明显缓解,脾脏缩小(P <0 .0 1)、门静脉、脾静脉内径缩小(P <0 . 0 1)。内镜套扎-部分脾栓塞联合术治疗门脉高压症具有简便、安全、效果显著、创伤小、并发症少等优点,是治疗肝硬化门脉高压症的一种新的途径。     

部分脾动脉栓塞术治疗肝硬化门静脉高压症的疗效及安全性观察

[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安全性。[方法]对48例不同原因肝硬化门静脉高压患者行PSE治疗,观察术前及术后1周、1、3、6个月血常规、肝功能、脾脏厚度、脾静脉和门静脉内径、Child-Pugh分级变化及并发症情况。[结果]PSE后患者白细胞和血小板计数均明显升高(P0.01);术后1个月患者脾静脉和门静脉内径明显缩小(P0.05,P0.01),术后6个月脾脏厚度明显缩小(P0.05);术后患者凝血酶原时间缩短(P0.01),总胆红素升高(P0.01),但谷草转氨酶、谷丙转氨酶及ChildPugh分级变化PSE前、后差异无统计学意义(P0.05);PSE后并发症较多,但未发现严重的并发症。[结论]PSE治疗肝炎肝硬化门静脉高压症合并脾功能亢进安全有效。     

介入栓塞治疗肝硬化脾功能亢进临床探讨

肝硬化门静脉高压致脾脏肿大、脾功能亢进，临床上较多见。我们于1999年6月～2002年6应用部分脾动脉栓塞术治疗脾功能亢进7例，取得满意疗效，现分析如下。     

Polyvinyl alcohol and gelatin sponge particle embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis

AIM: To assess the effectiveness of and complications associated with polyvinyl alcohol (PVA) and gelatin sponge particles embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis. METHODS: A 42-year-old man with splenic artery pseudoaneurysm formation secondary to chronic alcoholic pancreatitis was admitted. We used PVA and gelatin sponge particles embolization of splenic artery pseudoaneurysm by super-selective embolization techniques. RESULTS: The splenic artery pseudoaneurysm was successfully controlled with splenic embolization. The patient was discharged in 9 d with complete recovery. CONCLUSION: This case confirms that superselective transcatheter embolization by PVA and gelatin sponge particles may represent an effective treatment for pseudoaneurysm caused by chronic alcoholic pancreatitis in the absence of other therapeutic alternatives.     

Therapeutic effects of endoscopic variceal ligation combined with partial splenic embolization for portal hypertension

AIM: To evaluate the feasibility of a new strategy of endoscopic variceal ligation combined with partial splenic embolization (EVL-PSE) for patients with cirrhosis and portal hypertension. METHODS: From May 1999 to May 2002, 41 cases with cirrhosis and portal hypertension underwent EVL-PSE. Hemodynamics of the main portal vein (MPV), the left gastric vein (LGV) and azygos vein, including maximum velocity, flow rate and vein diameter, were assessed by Doppler ultrasonography. RESULTS: One case died from pulmonary artery embolism. One case complicated with splenic abscess was successfully managed by laparotomy. The esophageal varices and hypersplenism were well controlled after EVL-PSE in other patients. After EVL-PSE, the flow rate and velocity of MPV was significantly reduced (P<0.05), as well as the flow rate of the LGV and azygos vein. During the follow-up, no recurrent bleeding was found. CONCLUSION: Being more convenient and less invasive, EVL-PSE is hopeful to be a proper intervention strategy for portal hypertensive patients with impaired hepatic function or those intolerant to shunting or devascularization surgery.     

经脾动脉灌注低分子右旋糖酐在门脉高压症断流术中的应用

目的 探讨门脉高压症断流术中应用低分子右旋糖酐经脾动脉灌注,对预防门静脉系统血栓形成的效果。方法 选取本院2009年1月-2013年10月门脉高压症断流术患者92例,随机分为2组,对照组46例行脾切除及贲门周围血管离断术,实验组46例行门脉高压断流术,且术中应用低分子右旋糖酐脾动脉灌注,对2组病例术后门静脉血栓发生率、术中术后输血量进行统计分析。结果 实验组患者术后门静脉血栓发生率为4.3%（2/46）,浓缩红细胞输血量2 ~ 3 U,对照组患者血栓发生率及浓缩红细胞输血量分别为26.1%（12/46）和4 ~ 6 U,差异有统计学意义（P均< 0.05）。结论 术中经脾动脉低分子右旋糖酐灌注在门脉高压症脾切除术中操作安全可行,能有效降低术后门静脉系统血栓的发生率,且节约血源,减少用血量,值得临床推广应用。     

Clinical studies of new material for portal vein embolization: comparison of embolic effect with different agents

BACKGROUND/AIMS: Study of he embolic materials is necessary to select those suitable for preoperative portal embolization which increases the safety of hepatectomy. METHODOLOGY: Twenty-three patients with biliary tract cancer and hepatic tumor underwent portal embolization of the right portal vein. Four kinds of embolic materials were used. Gelatin sponge was used in 9, cyanoacrylate in 4, fibrin glue in 2, and gelatin sponge with polidocanol in 8 patients. The embolic effect in inducing hypertrophy as well as the surgical results were compared for different embolic agents. Left lobe hypertrophy was evaluated by computed tomography volume before and 2 weeks after portal embolization. RESULTS: With gelatin sponge, the volumetric increase was 21.9%, compared to 25% with cyanoacrylate, 13.5% with fibrin glue, and 35.3% for gelatin sponge with polidocanol. The volume increase of gelatin sponge with polidocanol was superior to those of other agents. In 18 of the 21 patients, hepatectomies with/without pancreaticoduodenectomy were performed. In 11 patients using the first 3 of the above-mentioned agents, 2 operative procedures were changed to limited hepatic resection, and 3 patients died of hepatic failure due to insufficient hypertrophy. Seven patients for whom gelatin sponge with polidocanol was used underwent the proposed operations with good results. CONCLUSIONS: Gelatin sponge with polidocanol induced sufficient hypertrophy and was the most suitable agent for portal embolization.     

肝硬化患者肝功能失代偿状况与门脉管径的关系

目的:探讨肝硬化患者肝功能失代偿状况、食管静脉曲张程度与门脉主干内径及脾静脉内径的关系。方法:对100例肝硬化失代偿期患者进行肝功能Child-pugh分级,内镜检查判断食管静脉曲张程度,彩色多谱勒B超检测门静脉主干内径及脾静脉内径。结果:肝功能分级越差,门静脉与脾静脉的内径越大(P<0.05),且随着门静脉及脾静脉内径增大,食管静脉曲张程度亦加重(P<0.05)。结论:门静脉及脾静脉内径能间接体现门静脉高压的程度,继而反映肝功能失代偿状况。     

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。     

Splanchnic Hemodynamics in Idiopathic Portal Hypertension: Comparison with Chronic Persistent Hepatitis

A comparative study of splanchnic hemodynamics was made in 12 patients with idiopathic portal hypertension and in eight patients with chronic persistent hepatitis, but without portal hypertension, who served as the control. Venous pressures were measured by portal and hepatic vein catheterizations, blood flow by the pulsed Doppler flowmeter, and organ volume by computed tomography. Splenic artery blood flow was 788 +/- 242 ml/min in idiopathic portal hypertension and about four times that in chronic persistent hepatitis (215 +/- 42 ml/min), whereas there was no difference in superior mesenteric artery blood flow between the former and the latter (408 +/- 142 vs. 389 +/- 32 ml/min). Spleen volume in idiopathic portal hypertension was six times that in chronic persistent hepatitis, and splenic artery blood flow showed a significant linear correlation with spleen volume in idiopathic portal hypertension (r = 0.71, p less than 0.02). The sum of splenic artery blood flow and superior mesenteric artery blood flow in idiopathic portal hypertension was 1195 +/- 294 ml/min, twice that in chronic persistent hepatitis (603 +/- 109 ml/min). Portal vascular resistance and intrahepatic portal vascular resistance were three times and four times those in chronic persistent hepatitis, respectively. These results indicate that both increased intrahepatic portal vascular resistance and increased splenic artery blood flow may play roles in the development of portal hypertension in idiopathic portal hypertension.     

Murine study of portal hypertension associated endothelin-1 hypo-response

AIM:To investigate endothelin-1 hypo-responsive associated with portal hypertension in order to improve patient treatment outcomes.METHODS:Wild type,e NOS-/-and i NOS-/-mice receivedpartial portal vein ligation surgery to induce portal hypertension or sham surgery.Development of portal hypertension was determined by measuring the splenic pulp pressure,abdominal aortic flow and portal systemic shunting.To measure splenic pulp pressure,a microtip pressure transducer was inserted into the spleen pulp.Abdominal aortic flow was measured by placing an ultrasonic Doppler flow probe around the abdominal aorta between the diaphragm and celiac artery.Portal systemic shunting was calculated by injection of fluorescent microspheres in to the splenic vein and determining the percentage accumulation of spheres in liver and pulmonary beds.Endothelin-1 hypo-response was evaluated by measuring the change in abdominal aortic flow in response to endothelin-1 intravenous administration.In addition,thoracic aorta endothelin-1contraction was measured in 5 mm isolated thoracic aorta rings ex-vivo using an ADI small vessel myograph.RESULTS:In wild type and i NOS-/-mice splenic pulp pressure increased from 7.5±1.1 mm Hg and 7.2±1 mm Hg to 25.4±3.1 mm Hg and 22±4 mm Hg respectively.In e NOS-/-mice splenic pulp pressure was increased after 1 d(P=NS),after which it decreased and by 7 d was not significantly elevated when compared to 7 d sham operated controls(6.9±0.6 mm Hg and 7.3±0.8 mm Hg respectively,P=0.3).Abdominal aortic flow was increased by 80%and 73%in 7 d portal vein ligated wild type and i NOS when compared to shams,whereas there was no significant difference in 7 d portal vein ligated e NOS-/-mice when compared to shams.Endothelin-1 induced a rapid reduction in abdominal aortic blood flow in wild type,e NOS-/-and i NOS-/-sham mice(50%±8%,73%±9%and 47%±9%respectively).Following portal vein ligation endothelin-1 reduction in blood flow was significantly diminished in each mouse group.Abdominal aortic flow was reduced by 19%±9%,32%±10%and 9%±9%in wild type,e NOS-/-and i NOS-/-mice respectively.CONCLUSION:Aberrant endothelin-1 response in murine portal hypertension is NOS isoform independent.Moreover,portal hypertension in the portal vein ligation model is independent of ET-1 function.     

超声检查诊断肝硬化门静脉高压症临床价值研究

目的 研究超声检查在肝硬化门静脉高压症诊断中的临床价值。方法 选择2008年1月~2015年9月我院诊治的肝硬化门静脉高压症患者80例和体检健康者75例,使用纤维内镜进行胃镜检查,判断食管胃底静脉曲张程度,使用意大利百胜Mylab60全数字化多普勒超声诊断仪测量门静脉内径、脾静脉内径、门静脉血流量和脾静脉血流量。结果 肝硬化患者门静脉内径、脾静脉内径、门静脉血流量和脾静脉血流量分别为（1.4±0.6） cm、（1.2±0.3） cm、（1023.2±653.4） mL/min和（593.3±112.3） mL/min,均明显高于健康人【（0.9±0.2） cm、（0.6±0.4） cm、（916.3±254.2） mL/min和（325.6±96.4） mL/min,P<0.05】;46例门静脉内径≥1.4 cm组轻度曲张发生率为19.6%,明显低于34例门静脉内径<1.4 cm组的52.9%（P<0.05）,门静脉内径≥1.4 cm组重度曲张发生率为52.2%,明显高于门静脉内径<1.4 cm组的20.6%（P<0.05）;49例脾静脉内径≥1.0 cm组轻度曲张发生率为20.4%,明显低于31例脾静脉内径<1.0 cm组的51.6%（P<0.05）,脾静脉内径≥1.0 cm组重度曲张发生率为51.0%,明显高于脾静脉内径<1.0 cm组的22.6% （P<0.05）。结论 超声检查诊断肝硬化门静脉高压症具有较高的敏感性和特异性,对食管胃底静脉曲张的轻重程度也具有良好的诊断价值,能为评价患者的肝功能和选择治疗方案提供重要的参考依据。