有效控制脾栓塞量治疗脾功能亢进

目的探索一种简单、准确、有效的部分性脾栓塞（PSE）栓塞量的控制方法和理想的栓塞材料。方法用高温高压处理过的明胶海绵粉末与碘化油的混合剂,超选择栓塞脾下叶或中叶动脉,达到靶动脉完全填充,同时夹心式给予头孢他啶（复达欣）1g和利多卡因20～40mg治疗脾功能亢进38例。术后定期复查血象;术后1个月行B超或CT检查,计算脾栓塞体积,并做钡餐造影或胃镜检查。结果术后各时段白细胞、血小板均明显高于术前（P〈0.05）;脾栓塞范围在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。结论超选择栓塞脾下叶或中叶动脉,控制栓塞量,治疗脾功能亢进,简单、准确、有效。栓塞并发症少,症状轻。高温高压处理过的明胶海绵粉末和碘化油的混合剂是理想的栓塞剂。

Valid control splenic embolism dose in treatment of the hypersplenia

Objective To explore a simple,safe and effective method of partial splenic embolization(PSE) and ideal embolization material. Methods Thirty-eight hypersplenia patients. The mixture of gelatin sponge powder and iodized oil treated with high temperature and high pressure was used to ultraselectively embolize the middle and inferior splenic lobal arteries completely,and the fortum(1g) and lidocaine(20-40 mg) were applied with sandwich method simultaneouly. Blood routine test was examed periodicly after operation,ultrasonagraphy and CT were taken 1 month after operation to calculate the embolization volume,barium meal and gastroscopy were taken to observe the varix state. Results White blood cells and platelets were obviously higher after operation than before at different time with efficacy rate of 100%(P<0.05). Embolization volume was 35%-50%,and varix in esophago-gastric fundus lightened with different degree. No splenic abscess,pleural effusion or pulmonary infection occurred. Conclusion Embolizing the middle and inferior splenic lobal arteries ultraselectively is a simple,safe and effective method in treating hypersplenia. The incidence of embolization syndrom is lower,its symptom is mild,and the serious complication is little. The mixture of gelatin sponge powder and iodized oil treated with high temperature and high pressure is a good embolization material.