不同栓塞材料行部分性脾栓塞治疗脾功能亢进的疗效及术后反应对比  

Curative effect and postoperative responses after partial splenic embolization with different embic materials for hypersplenism:a comparative analysis

作　　者：肖运平[1] 肖恩华[2] 刘惕生[1] 罗建光[2] 尚全良[2] 颜荣华[2] 

机构地区：[1]广西医科大学第五附属医院柳州市人民医院放射科,广西壮族自治区柳州市545001 [2]中南大学湘雅二医院放射科,湖南省长沙市410011

出　　处：《世界华人消化杂志》2008年第13期1430-1434,共5页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.30070235;No.30470508;湖南省自然科学基金资助项目;No.06JJ20081~~

摘　　要：目的:探讨不同栓塞材料在部分性脾栓塞术(partial splenic embolization,PSE)治疗脾功能亢进(脾亢)中的临床价值.方法:43例脾功能亢进行PSE患者,依据PSE术所采用的栓塞材料不同分为3组:A组14例,栓塞材料为00000真丝线段;B组13例,栓塞材料为300-500μm的聚乙烯泡沫醇(PVA)颗粒.C组16例,栓塞材料为明胶海绵颗粒.随访观察3组外周血白细胞、血小板计数变化及术后反应.结果:各组术后1wk、1mo和6mo内白细胞计数均较术前明显升高(tA1wk=22.405,tA1mo=11.145,tA6mo=11.522;tB1wk=16.248,tB1mo=11.956,tB6mo=8.496;tC1wk=15.113,tC1mo=10.342,tC6mo=7.233;均P<0.01),血小板计数均较术前明显升高(tA1wk=13.708,tA1mo=12.399,tA6mo=11.622;tB1wk=14.609,tB1mo=12.284,tB6mo=10.727;tC1wk=14.056,tC1mo=10.590,tC6mo=8.388;均P<0.01),但各组同一时间段疗效差异无显著性.PSE术后各组患者均出现不同程度的疼痛和发热,A组38.5℃以上发热的发生率较B、C组更高(χ2=6.725,P<0.05),B组较A、C组疼痛的程度重、持续时间长(F=13.783,P<0.05).3组病例严重并发症均较少.结论:真丝线段、PVA颗粒及明胶海绵颗粒均可作为PSE治疗脾功能亢进的栓塞材料,三者近期临床疗效相近,术后反应有差异.AIM：To evaluate the clinical value of partial splenic embolization（PSE）with different embolic materials for hypersplenism. METHODS：Forty-three patients with hypersplenism were treated with PSE and followed up for 6 mo.According to the difference of embolicmaterials in PSE,43 patients were divided into 3 groups.Silk suture segments were used in group A（n=14）,while polyvinyl alcohol（PVA）particle and gelatin sponge were used in group B（n =13）and C（n=16）,respectively.The follow-up indices included white blood cell（WBC）count, platelet（PLT）count and postoperative responses after PSE. RESULTS：In 3 groups,WBC and PLT counts were significantly higher after PSE than those pre-embolization 1 wk,1 mo,and 6 mo（WBC： tA1wk=22.405,tA1mo=11.145,tA6mo=11.522;tB1wk =16.284,tB1mo=11.956,tB6mo=8.496;tC1wk= 15.113,tC1mo=10.342,tC6mo=7.233;all P〈0.01; PLT：tA1wk=13.708,tA1mo=12.399,tA6mo=11.622; tB1wk=14.609,tB1mo=12.284,tB6mo=10.727;tC1wk =14.056,tC1mo=10.590,tC6mo=8.388;all P〈0.01）, but there was no marked difference in curative effect among the 3 groups.Abdominal pain and fever were the most frequent postoperative responses,and the occurrence rate of fever up to 38.5℃was higher in group A than that in group B or C（χ^2=6.725,P〈0.05）.The degree of abdominal pain was higher while the duration was longer in group B（F=13.783,P〈0.05）. Complications occurred less frequently in all the patients. CONCLUSION：Silk suture segments,PVA and gelatin sponge can be used as the embolic materials of PSE in patients with hypersplenism,and they are proximate in curative effect and differential in postoperative responses.

关 键 词：脾功能亢进 栓塞 治疗性 栓塞材料 

分 类 号：R575.2[医药卫生—消化系统]