功能性血流脾动脉栓塞术治疗脾功能亢进130例  

Treatment of hypersplenism by functional splenic embolization:analysis of 130 cases

作　　者：褚建国[1] 黄鹤[1] 孙鹏[1] 孙晓丽[2] 马璐娜[3] 

机构地区：[1]中国人民解放军空军总医院放射线科,北京市100036 [2]中国人民解放军空军总医院中心实验室,北京市100036 [3]中国人民解放军空军总医院核医学科,北京市100036

出　　处：《世界华人消化杂志》2010年第34期3704-3708,共5页World Chinese Journal of Digestology

摘　　要：目的:评价功能性脾动脉血流栓塞术(FSE)的安全性和可行性,探讨其潜在的临床意义.方法:将130例门静脉高压症行经颈静脉肝内门体分流(TIPS)术患者分为两组,行部分脾动脉栓塞术(PSE)67例,FSE63例.TIPS术前静脉曲张出血121例,难治性腹水9例;Child's B级53例、C级77例.TIPS术后7d或30d内行PSE或FSE.PSE导管端超选择置于脾下极脾段动脉,FSE导管端置于脾动脉远1/3处,PSE采用500-700μm海藻酸钠微球;FSE采用500-700μm Embosphere生物微球随脾动脉功能性血流自然漂流栓塞.结果:两组TIPS术后共130例患者,脾动脉栓塞术均获成功,技术成功率100%,两组术后白细胞、血小板回升曲线无明显差异,均是术后迅速升高,然后缓慢下降,3d左右达最高峰,然后缓慢下降,逐渐至正常水平.两组患者术后临床反应存在显著差异,PSE组患者术后出现严重高热及脾区疼痛;FSE组患者无明显术后并发症.PSE组术后针对并发症治疗的退热剂、镇痛剂、抗生素使用量及平均住院时间与FSE组存在显著差异(P<0.001).平均随访216d.结论:采用Embosphere生物微球的功能性脾动脉血流栓塞术FSE安全可行,术后并发症甚微,功能性脾动脉血流是脾脏功能亢进活跃区的血供来源,刻意超选择性插管脾下极脾段动脉分支及使用血液环境膨胀系数较大的栓塞剂进行PSE是造成术后严重并发症的重要原因.AIM：To assess the safety and feasibility of func-tional splenic embolization（FSE）in the manage-ment of hypersplenism.METHODS：A total of 130 patients with portal hypertension after transjugular intrahepatic por-tosystemic shunt（TIPS）were divided into two groups：one undergoing partial splenic embo-lization（PSE,n=67）and the other undergoing functional splenic embolization（n=67）.Of all the patients,121 had variceal bleeding before TIPS and 9 had refractory ascites;53 had Child-Pugh grade B liver function and 77 had grade C liver function.Seven or 30 days after TIPS,PSE or FSE was performed.The catheter wasplaced in the splenic artery to the lower pole of the spleen in the PSE procedure but in the distal one-third of the splenic artery in the FSE proce-dure.Alginate microspheres（500-700μm）were used for PSE procedure,while Embosphere mi-crospheres（500-700μm）were used in the FSE procedure.RESULTS：Splenic artery embolization was successful in all the patients,and the success rate was 100%.There was significant differ-ence in clinical response between the PSE and FSE groups.Severe postoperative pain,high fever and spleen pain were noted in patients in the PSE group,while patients in the FSE group developed no postoperative complications.No significant difference was noted in postoperative WBC and PLT recovery between the two groups.However,significant differences were noted in the use of antipyretics,analgesics and antibiot-ics for treatment of postoperative complications and the average length of hospital stay between the two groups.The average follow-up period was 216 d.CONCLUSION：Functional splenic embolization is safe and feasible for management of hyper-splenism.

关 键 词：栓塞剂 脾栓塞术 肝硬化 脾功能亢进 介入治疗 

分 类 号：R575.2[医药卫生—消化系统]