脾动脉阻断技术在射频消融治疗门脉高压性脾功能亢进症中的应用

目的探讨脾动脉阻断技术联合脾脏射频消融（RFA）治疗门静脉高压性脾功能亢进症（脾亢）的有效性和临床应用前景。方法对阻断或未阻断脾动脉主干的接受脾脏RFA治疗的肝硬化性门静脉高压合并重症脾亢患者,分析随访6个月的临床疗效;并评估脾动脉阻断对肝硬化合并脾动脉盗血综合征的治疗效果。结果阻断或未阻断脾动脉主干的接受脾脏RFA治疗的门脉高压性脾亢患者各15例,术后未发生严重并发症。阻断脾动脉后实施脾脏RFA组消融（56±35）%脾脏体积,较未阻断脾动脉组消融体积（38±21）%显著增加（P〈0.01）;且阻断脾动脉组治疗后血小板计数、Child-Pugh评分和分级改善明显优于未阻断脾动脉组。合并巨脾的脾动脉阻断组15例患者经影像学诊断都符合脾动脉盗血综合征诊断,经脾动脉栓塞（13例）和脾动脉结扎（2例）后肝动脉内径显著增粗,肝动脉供血明显改善。结论脾动脉阻断联合脾脏射频消融术是治疗门静脉高压性脾亢,可以显著提高脾亢治疗的安全性和有效性,同时纠正脾动脉盗血综合征和有效改善肝功能。

The application of occlusive techniques of the splenic artery combined with radiofrequency ablation for hypersplenism due to portal hypertension

Objective To investigate the efficacy and clinical prospects of occlusion of the splenic artery combined with radiofrequency ablation（RFA） for severe hypersplenism in patients with liver cirrhosis and portal hypertension.Methods The patients undergoing splenic RFA with or without simultaneous splenic artery occlusion were followed-up over a 6-month period to assess the clinical efficacy;the roles of splenic artery occlusion on splenic artery steal syndrome also were evaluated.Results Two groups of with or without splenic artery occlusion recruited fifteen patients each undergoing splenic RFA,no procedure-related complications occurred.The ablated splenic volume markedly increased in patients with splenic artery occlusion（56±35）%,compared with patients without splenic artery occlusion（38±21）%（P0.01）;the patients undergoing RFA with splenic artery occlusion had more significant increase of platelet counts,and better improvement of Child-Turcotte-Pugh classification and score,compared with patients without splenic artery occlusion.The diagnosis of splenic artery steal syndrome was confirmed on radiologic imagings in all the 15 patients with massive splenomegaly,after occlusion of the splenic artery by splenic artery coil emoblization in 13 cases and splenic artery ligation in 2 cases,the calibers of hepatic artery enlarged significantly and ensuing improved arterial supply of the liver.Conclusion The combination of splenic artery occlusion and splenic RFA can improves the safety and efficacy for the management of severe hypersplenism due to liver cirrhosis and portal hypertension,and can correct splenic artery steal syndrome and ameliorate the hepatocellular function.