血管介入在肝硬化脾功能亢进中的应用研究进展

肝硬化是引起继发性脾功能亢进的常见原因,脾功能亢进常常导致患者外周血细胞降低,当白细胞和血小板严重减少时,患者易发生自发性感染和出血,进而加重病情,增加死亡风险.目前对肝硬化脾功能亢进发生机制尚不十分清楚,亦无脾亢治疗适应症标准和合适推荐方法,临床上脾亢的治疗方式有:脾切除术,血管介入术,局部热消融及脾动脉结扎术等.血管介入术主要涉及经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)和部分脾动脉栓塞术(partial splenic embolization,PSE),其中TIPS是治疗肝硬化门脉高压并发症的有效方法,它能有效降低门脉压力,但能否缓解脾亢仍存在争议;PSE对脾亢有一定程度的缓解;TIPS联合PSE应用,在有效降低门脉高压同时对脾亢也能一定程度缓解.本文就血管介入在肝硬化脾亢应用研究进展进行综述.

Applications of vascular interventions in hypersplenism in liver cirrhosis

Cirrhosis is a common cause of secondary hypersplenism.Hypersplenism often leads to a decrease in peripheral blood cells,and when the numbers of leukocytes and platelets are severely reduced,patients are prone to spontaneous infections and bleeding,which can aggravate the disease and increase the risk of death.The mechanism of hypersplenism in cirrhosis is not well understood,and there is no standard indication or recommended method for the treatment of hypersplenism.Clinical treatment options for hypersplenism include splenectomy,vascular intervention,local thermal ablation,and splenic artery ligation.Vascular interventions mainly involve transjugular intrahepatic portosystemic shunt(TIPS)and partial splenic embolization(PSE).TIPS is an effective method to treat the complications of portal hypertension in cirrhosis,which can effectively reduce portal pressure,but whether it can relieve hypersplenism is still controversial.PSE can relieve hypersplenism to a certain extent.TIPS combined with PSE can effectively reduce portal hypertension and relieve hypersplenism to a certain extent.This article reviews the applications of vascular interventions in hypersplenism in cirrhosis.