部分脾动脉栓塞术与脾切除术治疗肝豆状核变性合并脾亢的疗效比较  

Comparison of curative effect between partial splenic embolization and splenectomy for hepatolenticular degeneration with hypersplenism

作　　者：幸伟芳 周志华 黄叶青[1] 危智盛[1] 洪铭范[1] XING Weifang;ZHOU Zhihua;HUANG Yeqing;WEI Zhisheng;HONG Mingfan(Department of Neurology,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guang?zhou 510000,China)

机构地区：[1]广东药科大学附属第一医院神经内科,广州510000

出　　处：《实用医学杂志》2019年第21期3333-3337,3342,共6页The Journal of Practical Medicine

基　　金：广东省中医药局面上项目(编号：20180320230014)

摘　　要：目的比较部分脾动脉栓塞术(partial splenic embolization,PSE)与脾切除术治疗肝豆状核变性(hepatolenticular degeneration,HLD)合并脾功能亢进(脾亢)的疗效。方法收集广东药科大学附属第一医院2006年3月至2016年12月收治的22例HLD合并脾亢行PSE和脾切除术病例,PSE组10例,脾切除术组12例,随访2年,收集患者的一般信息、血常规、肝功能、凝血指标、术后主要并发症和随访情况。结果PSE与脾切除术均可使白细胞和血小板升高,两组术后白细胞、血小板对比差异有统计学意义(P<0.05)。PSE组与脾切除术组术后红细胞和血红蛋白对比,仅术后第7天时差异有统计学意义(P<0.05)。PSE组术后1年与术前的丙氨酸氨基转移酶对比下降(P=0.007);两组术后1年的总胆红素与术前对比明显下降(PPSE=0.035,P脾切=0.0001)。但白蛋白前后无明显变化(P>0.05)。两组术后1年的PT均较术前缩短改善(P<0.05);脾切除术组术后APTT与术前对比均缩短(P<0.05)。两组术后主要并发症都是发热和腹胀、腹痛,PSE组并发症较轻。两组术后神经系统症状均未加重。结论PSE和脾切除术均可有效改善HLD合并脾亢所致的血细胞三系减低、肝功能和凝血指标。虽PSE部分疗效不如脾切除术显著,但PSE具有相对安全、创伤小,术后并发症较轻,手术指征要求低,可重复治疗的优势,值得临床推广应用。Objective To compare the curative effect between partial splenic embolization(PSE)and splenectomy for hepatolenticular degeneration(HLD)with hypersplenism.Methods A total of 22 cases in which patients were diagnosed as HLD with hypersplenism and underwent PSE or splenectomy in the First Affiliated Hos?pital of Guangdong Pharmaceutical University from March 2006 to December 2016 were collected.Among them,10 cases were in the PSE group and 12 cases in the splenectomy group.The patients were followed for 2 years.Data of patient′s general information,routine blood,liver function,blood coagulation function,main postoperative compli?cations and follow?up situation were collected for statistical analysis using the software SPSS version 20.Results Both PSE and splenectomy could increase white blood cells and platelets.The difference of white blood cells and platelets after operation between PSE group and splenectomy group was statistically significant(P<0.05).Only the seven days′red blood cells and hemoglobin after operation between PSE group and splenectomy group was sta?tistically significant(P<0.05).One year after surgery,the alanine aminotransferase was lower than that before in PSE group(P=0.007).The total bilirubin declined obviously after 1 year operation(PPSE=0.035,psplenectomy=0.0001),but there was no obvious change for the albumin before and after operation(P>0.05).One year after surgery,the prothrombin time was shorter in both groups than that before operation(P<0.05).Postoperative activated partial thromboplastin time of splenectomy was shorter than that before operation(P<0.05).The major postoperative complications of two groups were fever,abdominal distension and abdominal pain.By contrast,the complications in PSE group was milder.Postoperative neurological symptoms were not aggravated in all patients.Conclusions Both PSE and splenectomy can improve the problem of three hematopoietic cell lines,liver function and coagulation functioncaused by hypersplenism.Although PSE is less effective than splenectomy

关 键 词：肝豆状核变性 部分脾动脉栓塞术 脾切除术 疗效 并发症 

分 类 号：R73[医药卫生—肿瘤]