改良脾动脉栓塞治疗肝硬化性脾功能亢进及脾动脉盗血综合征的临床效果  

Clinical effect of modified splenic artery embolization in treatment of hypersplenism and splenic artery steal syndrome due to liver cirrhosis

作　　者：卢昊 许小亚[1] 叶进冬 郭栋 段留新 李长政 刘全达[1,2] LU Hao;XU Xiaoya;YE Jindong;et al(Institute of Hepatobiliary Gastrointestinal Diseases, General Hospital of the PLA Rocket Force, Beijing 100088, China)

机构地区：[1]火箭军总医院全军肝胆胃肠病中心,北京100088 [2]苏州大学,江苏苏州215006 [3]中国人民解放军总医院介入科,北京100853

出　　处：《临床肝胆病杂志》2017年第11期2141-2146,共6页Journal of Clinical Hepatology

基　　金：基金项目:北京市首都临床特色应用研究(Z141107002514110)

摘　　要：目的肝硬化合并脾功能亢进患者的粗大脾动脉竞争性"窃取"腹腔干血流,引起肝动脉灌注不足(即肝硬化性脾动脉盗血综合征)。探讨脾动脉主干联合分支动脉栓塞的改良脾动脉栓塞术纠正肝硬化性脾动脉盗血综合征及脾功能亢进的有效性。方法选取2007年1月-2015年12月在火箭军总医院和解放军总医院住院的脾功能亢进合并脾动脉盗血综合征的肝硬化患者220例,分成3组,即给予药物或联合内镜干预的内科治疗组(120例)、内科治疗基础上实施传统的部分脾栓塞组(PSE组,40例)和联合脾动脉主干及分支动脉栓塞的改良脾动脉栓塞组(MSAE组,60例),中位随访5年以上,并对3组间的相关指标进行比较分析。计量资料3组间比较利用单因素方差分析,进一步两两比较采用LSD-t检验;2组间比较采用t检验;计数资料组间比较采用χ~2检验;利用Kaplan-Meier生存分析法分析生存率和消化道出血率;log-rank法检验统计学差异。结果 MSAE组患者血小板、白细胞计数术后5年内整体水平显著高于内科治疗组(P值均<0.05)。术后6个月MSAE组Child-Pugh评分显著低于内科治疗组(P<0.001)和PSE组(P=0.014);术后1年MSAE组Child-Pugh评分仍显著低于内科治疗组(P=0.009);术后6个月MSAE组MELD评分显著低于内科治疗组(P=0.004)和PSE组(P=0.048);术后1年MSAE组MELD评分仍显著低于内科治疗组(P=0.012)。MSAE组消化道出血/再出血及内镜治疗次数显著低于PSE组和内科治疗组(χ~2=9.41,P=0.009;χ~2=10.91,P=0.004);术后5年MSAE组术后消化道出血/再出血发生率仍显著低于内科治疗组(χ~2=14.70,P=0.002)。MASE组术后并发症(发热、腹痛)程度及持续时间均有所改善,脾脓肿等严重并发症发生率更低。MSAE组中位生存时间45(8~91)个月,PSE组中位生存时间41(6~86)个月,内科治疗组中位生存时间34.5(7~84)个月。随访5年MSAE组死亡7例(11.7%),内科治疗组死亡40例(30%),PSE组死亡7例(17.Objective To investigate the clinical effect of modified splenic artery embolization of the splenic artery and branch arteries in the treatment of splenic artery steal syndrome（SASS） and hypersplenism due to liver cirrhosis,since in patients with liver cirrhosis complicated by hypersplenism,the enlarged splenic artery competitively＂steals＂the blood flow in the celiac trunk and causes hypoperfusion in the hepatic artery（i.e.,SASS due to liver cirrhosis）.Methods A total of 220 cirrhotic patients with hypersplenism and SASS who were hospitalized in General Hospital of the PLA Rocket Force and Chinese PLA General Hospital from January 2007 to December 2015 were enrolled and divided into medical treatment group with 120 patients（drugs combined with endoscopic intervention）,partial splenic embolization（PSE） with 40 patients（PSE combined with medical treatment）,and modified splenic artery embolization（MSAE） group with 60 patients（embolization of the splenic artery and branch arteries combined with medical treatment）.Related indices were analyzed and compared between the three groups.A one-way analysis of variance was used for comparison of continuous data between three groups,and the least significant difference t-test was used for further comparison between two groups;the chi-square test was used for comparison of categorical data between groups;the Kaplan-Meier survival analysis was used to calculate survival rates and gastrointestinal bleeding rate;the log-rank test was used to evaluate statistical difference.Results Within 5 years after surgery,the MSAE group had significantly higher platelet and leukocyte counts than the medical treatment group（P〈0.05）.At 6 months after surgery,the MSAE group had a significantly lower Child-Pugh score than the medical treatment group（P〈0.001） and the PSE group（P=0.014）;at 1 year after surgery,the MSAE group still had a significantly lower Child-Pugh score than the medical treatment group（P=0.009）.At 6 months after surgery,the MSAE

关 键 词：肝硬化 脾动脉盗血 改良型脾动脉栓塞 脾功能亢进 

分 类 号：R575.2[医药卫生—消化系统]