部分脾栓塞术与脾切除术治疗肝硬化并发脾功能亢进的疗效比较  

Comparison of efficacy of partial splenic artery embolization with splenic resection in treatment of hypersplenism caused by cirrhosis

作　　者：蒋妍[1] 李婧[1] 宋维平[1] 杨长青[1] JIANG Yan;LI Jing;SONG Wei-ping;YANG Chang-qing(Dept.of Gastroenterology,Tongji University School of Medicine,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院消化科

出　　处：《同济大学学报（医学版）》2019年第6期872-876,共5页Journal of Tongji University(Medical Science)

基　　金：国家自然科学基金(81670571);上海市临床重点专科建设项目(shslczdzk06801)

摘　　要：目的比较部分脾栓塞术(partial splenic embolization, PSE)与传统外科脾切除术在改善肝硬化患者脾功能亢进的疗效差异。方法纳入47例肝硬化脾亢患者,其中28例行脾切除术及19例行PSE,分析2组患者术后外周血三系水平、肝功能储备、手术相关并发症、外周血炎症因子水平、模拟门静脉压力值及门脉高压相关并发症等情况。结果两种治疗手段均有效改善肝硬化患者脾功能亢进,临床疗效差异无统计学意义。2组间术后MELD评分、门静脉压力和外周血炎症因子含量差异无统计学意义(P>0.05)。PSE后患者发生大出血事件较脾切除术少(P=0.025),且发生感染的风险低(P=0.044)。PSE方法创口小、保留部分脾脏功能并且引起血小板数量变化也较为平稳。结论 PSE与传统脾切除术临床效果无显著差异,但是其创伤性小、手术相关并发症少,相对于创伤性较大的脾切除术而言,PSE在肝硬化患者中的适用范围更广,可用于肝功能储备差的老年患者。Objective To compare the efficacy of partial splenic embolization(PSE) with spleen resection in treatment of hypersplenism caused by cirrhosis. Methods Forty seven patients of liver cirrhosis complicated with hypersplenism were enrolled in the study, among whom 19 patients were treated with partial splenic artery embolization(PSE group) and 28 were treated with splenectomy(resection group). The post-operation blood cell counts, hepatic functional reserve, operation-related complications, serum proinflammatory cytokines level and portal vein hypertension-related complications were compared between two groups. Results Both PSE and splenic resection released hypersplenism and there was no significant difference between two groups. There were no significant differences in post-operation MELD score, portal vein pressure and serum proinflammatory cytokines levels between two groups(P>0.05). Patients after PSE were less likely to have major bleeding events(P=0.025) and lower risk of infection(P=0.044). Compared with splenic resection, PSE caused less injury, reserved partial splenic function and had stable change of platelet level. Conclusion There is no significant difference in the efficacy between partial splenic artery embolization and splenectomy in treatment of hypersplenism caused by cirrhosis. PSE is a minimally invasive procedure with less post-operation complications, which is recommended for elderly patients with poor hepatic function reserve.

关 键 词：部分脾栓塞术 脾切除术 脾功能亢进 肝硬化 

分 类 号：R575.29[医药卫生—消化系统]