部分脾栓塞术治疗肝硬化脾功能亢进的疗效预测  

Partial splenic embolization for the treatment of thrombocytopaenia in cirrhotic hypersplenism

作　　者：蔡明岳[1] 黄文薮[1] 郭永建[1] 曾昭吝 周斌[1] 王皓帆[1] 秦潇潇[1] 朱康顺[1] 

机构地区：[1]中山大学介入放射学研究所中山大学附属第三医院放射科,广州510630

出　　处：《中华普通外科杂志》2014年第3期161-164,共4页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（81070349）;广东省科技计划基金资助项目（20108031600211）

摘　　要：目的探讨部分性脾栓塞术（partial splenic embolization，PSE）改善肝硬化脾功能亢进引起血小板减少的疗效预测因素。方法70例肝硬化脾功能亢进患者因严重血小板减少接受PSE治疗。以其中具有完整腹部cT及实验室检查资料、随访超过1年的34例为研究对象。通过cT影像后处理软件测量术前脾体积、非梗死脾体积，计算梗死脾体积及脾栓塞比例。对多个可能影响术后血小板升高的因素进行统计分析。结果34例患者脾栓塞比例平均为63．3％。术后1、6个月及1年血小板计数均较术前明显升高。Pearson相关性分析显示：术后1年血小板计数升高值与脾栓塞比例、胆碱酯酶水平呈显著正相关，而与非梗死脾体积呈负相关。多元线性回归分析建立回归方程：术后1年血小板计数升高值（×10^9/L）=-47．723＋1．514×脾栓塞比例（％）-0．054×非梗死脾体积（m1）＋0．005×胆碱酯酶（U/L），R。=0．808。ROC曲线分析确定术后1年血小板计数升高≥60×10^9/L时，脾栓塞比例及非梗死脾体积的最佳截断值分别为68．2％、211．5ml。结论脾栓塞比例、非梗死脾体积和胆碱酯酶水平是PSE疗效的独立预测因素。脾栓塞比例≥68．2％、非梗死脾体积≤211．5ml是确保疗效的重要因素。Objective To investigate the predictive factors for platelet （PLT） count increase after partial splenic embolization （PSE）. Methods Between January 2008 and December 2011, 70 patients with hypersplenism and severe thrombocytopaenia caused by cirrhotic portal hypertension were treated with PSE. Of these patients, 34 with a post-embolization follow-up for more than one year were included in this study. Based on the contrast enhanced abdominal CT images, the pretreatment splenic volume and non- infarcted splenic volume were measured on an imaging workstation using volumetric analysis software, the infarcted splenic volume and splenic infarction rate were calculated. Potential predictive factors for PLT increase after PSE were examined. Results 34 patients had a mean splenic infarction rate of 63.3%. The PLT count significantly increased from 39.4 × 109/L before PSE to 104. 9 × 10^9/L, 93.9 x 109/L and 89. 2 × 10^9/L at 1 month, 6 months and 1 year after PSE respectively. In correlation analysis, the splenic infarction rate and cholinesterase level were on a positive correlation with increase in PLT count at 1 year after PSE, whereas non-infarcted splenic volume on a negative correlation. Stepwise multiple linear regression analysis showed that the increase in PLT count at 1 year （ × 109/L） = - 47. 723 ＋ 1. 514 × splenic infarction rate （ % ） - 0. 054 x non-infarcted splenic volume （ ml ） ＋ 0. 005 × cholinesterase （U/L）, R^2 = 0. 808. The suitable cut-off value of splenic infarction rate and non-infracted splenic volume, for achieving an increase of ≥60 × 10^9/L in platelet count at 1 year after PSE, were 68.2% and 211.5 ml respectively. Conclusions The splenic infarction rate, non-infarcted splenic volume and cholinesterase level significantly affects the prolonged increase in PLT counts after PSE. A splenic infarction rate ≥68.2% and a non-infarcted splenic volume ≤211.5 ml cause a prolonged increase in PLT counts post-PSE.

关 键 词：肝硬化 脾功能亢进 脾栓塞 血小板减少 

分 类 号：R657.3[医药卫生—外科学]