肝硬化门脉高压脾功能亢进的部分栓塞治疗

目的：对36例肝硬化门脉高压脾机能亢进（简称脾亢）患者采用部分性脾栓塞术（Partialsplenicembolization，PSE）的治疗效果进行分析，找出确定其疗效的观测指标、栓塞范围和PSE的临床应用价值。材料和方法：术前患者周围血细胞计数三系均低，以白细胞、血小板降低为显著。选择性插入脾动脉靶血管后先造影然后用抗生素液浸泡的明胶海绵颗粒进行栓塞。结果：脾动脉插管技术成功率100％。30例外周血白细胞和血小板计数恢复到正常水平，5例部分缓解，1例无明显变化。术后凝血酶原时间（PT）缩短，凝血酶原活动度（PTA）增加，免疫球蛋白含量增加，食道静脉曲张程度有所下降。所有患者术后均出现栓塞后综合征，主要表现为发热和左上腹疼痛。无严重并发症发生。结论：PSE对脾亢患者是一种安全有效的治疗方法。既可减轻脾亢又保留了脾脏的免疫功能。在一定程度上可减轻门脉高压的症状。PSE栓塞范围在30％～80％之间为宜。白血球和血小板尤其是后者数量和功能改变为PSE后疗效可靠的观测指标。

Partial Splenic Embolization treatment in Patients with Portal Hypertension and Hypersplenism

To analyse the results treated with Partial splenic embolization(PSE) in 36 patients withportal hypertension and hypersplenism caused by cirrhosis in order to determine the effective observation in-dex,the range of embolization and the clinical value of PSE. for and Methods:All the patients hadlow peripheral blood count, especially low leukocyte and Platelet before the operation. After being selectedinserting splenic tartery, all the patients were made angiography and were embolized with particulategelatin sponge that was soaked by antibiotic. Results: The rate of success with the splenic embolizationthchnique was 100%. Peripheral blood leukocyte and platelet count in 30 Cases were up to normal,5caseswere partially recovered, 1 case didn' t chang. Prothrombin time shorted, Prothromtin Activity and thequantity of immunoglobulin increased and the edgree of esophageal varices decreased slightly after the oper-ation.The patients appeared postembolization syndrom, who had fever and abdominal pain and no severecomplication happened. Conclusion: PSE is a safe and effective treatment technique, which not ouly reduceshypersplenism,but also reserves the splenic immunity. For some degree, it can reduce the Symptom of por-tal hypertension the. The range of PSE is suitable from 30% to 80% The quantity and the function changeof leukocyte and platelet,especially that of the later, is a reliabe observation index after PSE.