褐藻胶微球及明胶海绵在脾栓塞术中的临床应用

目的：评价褐藻胶微球及明胶海绵作为栓塞材料在部分性脾栓塞术（PSE）治疗肝硬化脾功能亢进（脾亢）中的疗效及并发症。方法：2002~2005年74例肝硬化脾亢行PSE患者，依据PSE术所采用的栓塞材料不同分为2组：A组26例，栓塞材料为明胶海绵颗粒（直径约0.2～0.5mm）；B组48例，栓塞材料为250～450μm褐藻胶微球。随访观察二组外周血白细胞、血小板和红细胞计数变化及术后反应。选取术后1年资料完整的60例进行分析，其中A组22例，B组38例。结果：二组术后1年内白细胞和血小板计数均较术前明显升高（P<0.001）。虽然B组术后白细胞和血小板计数较A组升高较多，但二组的疗效差异无显著性（P>0.05）。二组术后红细胞计数一直无明显变化（P>0.05）。B组疼痛的程度重、持续时间长，而A组发热的发生率高，较严重并发症的发生率两组无明显差异。结论：作为PSE术的栓塞材料，褐藻胶微球较明胶海绵更安全、可靠。

Clinical application of brown algae-mibroballs particles and gelfoam in partial splenic embolization for hypersplenism in cirrhosis

Objective: To evaluate the efficacy and complications of partial splenic embolization(PSE) using brown algae microballs and gelfoam as embolic materials for hypersplenism in cirrhosis. Methods: Seventy-four patients with hypersplenism and cirrhosis were treated by PSE and followed up for 1 year. According to the difference of the embolic material in PSE, 60 patients were divided into 2 groups. Group A: 22 patients with gelfoam cubes as the embolic material of PSE and group B: 38 patients with brown algae microballs. The follow-up indices included peripheral blood cell counts(WBC, PLT, RBC) and the complications associated with PSE. Results: In group A and B, WBC and PLT counts kept significantly higher in number than pre-embolization from 2 weeks to 1 year after PSE(P<0.001). Though WBC and PLT counts reached higher level after PSE in group B than that in group A but without significant difference(P>0.05). RBC counts did not show significant changes after PSE within 1 year follow-up(P>0.05). The most frequent side-effects were belly ache and fever. The degree and duration of belly ache were higher and longer in group B than those in group A, but the occurrence rate of fever was lower in group B. The occurrence rate of severe complications showed no significant differences for the two groups. The increase of embolization degree may aggravate post-embolization side-effects and raise the incidence of complications. Conclusion: Brown algae microballs may be more safe than gelfoam as the embolic material for PSE.