部分性脾栓塞术治疗肝硬化脾功能亢进的远期疗效观察

目的　目的评价部分性脾栓塞术 (Partialsplenicembolization ,PSE)治疗肝硬化脾功能亢进的远期疗效。方法　对 1998年 5月以前采用PSE治疗的 6 2例肝硬化脾功能亢进患者进行长期随访 ,随访指标主要为外周血白细胞、血小板和红细胞计数。选取术后 1～ 5年资料完整的 38例进行分析 ,其中栓塞程度≥ 6 0 %者 2 3例 ,5 0 %～ 5 9%者 9例 ,<5 0 %者 6例。结果　白细胞和血小板计数分别于术后第 3天和 2周达到峰值 ,然后二者逐渐下降 ,但对不同的栓塞程度其下降趋势差异具有显著性意义 (P =0 .0 0 1)。栓塞程度≥ 6 0 %者 ,术后白细胞和血小板计数均较术前显著升高并一直维持到术后第 5年 (P <0 .0 0 1) ,且第 5年时白细胞计数仍为正常 ,第 4年时血小板计数仍达正常。栓塞程度5 0 %～ 5 9%者 ,术后白细胞和血小板计数也较术前明显升高并可达到术后第 5年和第 4年 (P <0 .0 5 )水平 ,但它们分别在术后第 2年和第 1年就降至正常范围以下。而对于栓塞程度 <5 0 %者 ,术后 1个月白细胞和血小板计数都降至正常范围以下。红细胞计数在术后一直无明显变化 (P >0 .0 5 )。随着栓塞程度的增加 ,术后反应加重 ,并发症也随之增加。结论　栓塞程度控制在 6 0 %～ 70 %可有效治疗肝硬化脾功能亢进 ,分次栓塞可减轻术后反应

Long-term efficacy of partial splenic embolization for hypersplenism in cirrhosis

Objective To evaluate the long-term efficacy of partial splenic embolization (PSE) for hypersplenism in cirrhosis.Methods Sixty-two patients with hypersplenism and cirrhosis were treated with PSE and followed for 5 years,and 38 of them with complete date were studied. The follow-up indices included peripheral blood cells counts: white blood cell (WBC),platelet (PLT) and red blood cell (RBC) According to the extent of embolization,38 patients were divided into 3 groups: more than 60% or 60% ( n = 23),50% to 59% ( n = 9),and less than 50% ( n = 6). Results WBC and PLT counts reached peak level at the third day and second week respectively after PSE,then they gradually fell,but the decreasing tendency had significant differences among different embolization groups ( P = 0. 001 ) . In patients with more than 60% or 60% embolization degree,WBC and PLT counts kept significantly higher than pre-embolization values from 2 weeks to 5 years after PSE (P <0. 001 ),and they remained normal at the fifth year and forth year respectively. In patients with embolization degree ranged from 50% to 59%,WBC and PLT counts kept significantly higher than pre-embolization values from 2 weeks to 5 years and 4 years respectively after PSE (P < 0. 05),but they reduced to be lower than normal values at the second year and first year respectively. In patients with less than 50% embolization degree,WBC and PLT counts decreased to be lower than normal values at the first month after PSE. RBC counts did not show significant changes after PSE during short- or long-term follow-up (P > 0. 05). The increase of embolization degree may aggravate post-embolization syndrome and increase the incidence of complications. Conclusion The embolization degree ranged from 60% to 70% may alleviate hypersplenism in patients with cirrhosis. Divided by stages embolization may relieve post-embolization syndrome and decrease the incidence of complications.