可解脱球囊治疗门静脉高压和脾功能亢进的疗效观察  

Efficacy of splenic artery trunk embolization with detachable balloon for portal hypertension and hypersplenism

作　　者：王承恩[1] 孙成建[1] 王彦华[1] 刘彤晖[1] 解玲玲[1] 任伟超[1] 

机构地区：[1]青岛大学附属医院介入医学科,266003

出　　处：《中华肝脏病杂志》2015年第6期433-436,共4页Chinese Journal of Hepatology

摘　　要：目的 观察可解脱球囊栓塞脾动脉主干在治疗肝硬化性门静脉高压伴脾功能亢进中的疗效. 方法 对8例肝硬化性门静脉高压和脾功能亢进的患者在数字减影血管造影机引导下应用可解脱球囊行脾动脉断流术,应用超声测量门静脉、肠系膜上静脉、脾静脉及肝动脉主干管腔内径、血流量;检测白细胞、红细胞、血小板、白蛋白、总胆红素、ALT、AST、凝血酶原活动度（％）;胃镜检查食管胃底静脉曲张转归情况;记录围手术期并发症情况.计量资料比较用配对t检验,等级资料比较用Wilcoxon秩和检验. 结果 8例患者术后门静脉内径由术前的（1.55±0.38） cm减小至（1.55±0.38）cm,t=16.55,P＜0.05;脾静脉内径由（1.45±0.10） cm减小至（1.41±0.09） cm,t=4.15,P＜ 0.05.门静脉血流量由术前的（971.52±174.77） ml/min减少到（785.86±100.17）ml/min,t=6.32,P＜ 0.05;脾静脉血流量由（938.01±208.86） ml/min降低到（644.02±188.15） ml/min,t=34.91,P＜0.05;肝动脉血流量由（261.25±65.47） ml/min增加至（449.32±84.05）ml/min,t=13.61,P＜0.05.肝功能、凝血功能明显改善,脾功能亢进得到有效缓解,血小板由术前的（37.75± 10.61）×109/L升至（138.63±28.22）×109/L,t=15.89,P＜ 0.05;静脉曲张明显好转,围手术期无严重并发症及死亡事件发生. 结论 可解脱球囊栓塞脾动脉主干治疗肝硬化性门静脉高压和脾功能亢进安全、有效,值得在临床推广.Objective To investigate the efficacy of detachable balloon for splenic artery trunk embolization in patients with cirrhotic portal hypertension and hypersplenism.Methods Eight patients with cirrhotic portal hypertension received splenic artery trunk disconnection using detachable balloons under the guidance of digital subtraction angiography.The diameter and blood flow of the portal vein,the superior mesenteric vein,the splenic vein and the hepatic artery were measured by color Doppler ultrasound.Markers of liver function and blood coagulation,and routine blood parameters were assessed.Gastroscopy was used to evaluate to the degree of gastroesophageal varices.All complications experienced during the perioperative period were recorded.Results The portal vein diameter decreased from 1.55±0.38 cm to 1.55±0.38 cm,and the splenic artery diameter decreased from 1.45±0.10 cm to 1.41±0.09 cm （P 〈 0.05）.The portal vein blood flow was reduced from 971.52±174.77 ml/min to 785.86±100.17 ml/min,and the splenic vein blood flow decreased from 938.01±208.86 ml/min to 644.02±188.15 ml/min,while the hepatic artery blood flow increased from 261.25±65.47 ml/min to 449.32±84.05 ml/min （P 〈 0.05）.The symptoms of splenism were improved effectively,with platelet counts rising from 37.75±10.61×109/L to 138.63±28.22×109/L after the procedure （P 〈 0.05）.There were no episodes of severe complications or death in the perioperative period,and all patients showed remarkable improvement in markers of liver function and coagulation function,and improvement of esophagogastric varices.Conclusions The interventional disconnection technique of the splenic artery trunk using detachable balloon for the treatment of portal hypertension and hypersplenism is safe and effective.

关 键 词：肝硬化 高血压 门静脉 脾功能亢进 可解脱球囊 

分 类 号：R575.2[医药卫生—消化系统]