部分脾动脉栓塞与脾切除治疗脾功能亢进症的疗效比较  

Comparison of efficacy between partial splenic artery embolization and splenectomy for hypersplenism

作　　者：王菲 徐佰国 王凤梅 韩涛[1] WANG Fei;XU Bai-guo;WANG Feng-mei(Three center Clinical College of Tianjin Medical University,Tianjin 300170,China)

机构地区：[1]天津医科大学三中心临床学院,300170

出　　处：《中国实用医药》2020年第3期12-15,共4页China Practical Medicine

摘　　要：目的通过对部分脾动脉栓塞和脾切除治疗脾功能亢进症的治疗费用、疗效及并发症进行分析,评价两种方法治疗脾功能亢进症的特点。方法92例脾功能亢进症行部分脾动脉栓塞治疗患者作为脾栓塞组,208例脾功能亢进症行脾切除治疗患者作为脾切除组。比较两组患者住院天数及住院费用;术前、术后的白细胞(WBC)、红细胞(RBC)、血小板(PLT)水平;并发症发生情况。结果两组患者手术均安全、顺利、成功。脾栓塞组住院天数(23.39±10.15)d短于脾切除组的(31.54±11.08)d,住院费用中位数2.77万元少于脾切除组的4.82万元,差异均具有统计学意义(P<0.05)。术前,两组患者的WBC、RBC、PLT水平比较,差异均无统计学意义(P>0.05);脾栓塞组术后3、7、14、21 d的WBC、PLT水平均低于脾切除组,术后3 d的RBC水平高于脾切除组,差异均具有统计学意义(P<0.05);两组患者术后7、14、21 d的RBC水平比较,差异均无统计学意义(P>0.05)。脾栓塞组患者的腹水感染、脾周脓肿、门静脉血栓形成、发热、肝性脑病、腹泻发生率分别为25.00%、2.17%、0、88.04%、1.09%、2.17%,与脾切除组的42.79%、0、25.00%、98.08%、19.71%、0比较,差异均具有统计学意义(P<0.05);两组患者的腹水、腹痛、左下肺不张、肺炎、腹腔血肿、其他发生率比较,差异均无统计学意义(P>0.05)。结论部分脾动脉栓塞和脾切除均为治疗脾功能亢进症的有效方法,近期治疗效果明确。部分脾动脉栓塞更适合肝功能差、不能耐受外科手术的患者。Objective To evaluate the characteristics of partial splenic artery embolization and splenectomy for hypersplenism by analyzing treatment cost,efficacy and complications.Methods There were 92 hypersplenism patients undergoing partial splenic artery embolization selected as splenic embolization group,and 208 hypersplenism patients undergoing splenectomy selected as splenectomy group.The hospitalization time and hospitalization costs,levels of white blood cell(WBC),red blood cell(RBC)and platelet(PLT)before and after operation,and occurrence of complications were compared between the two groups.Results The operation in both groups was safe,smooth,and successful.The hospitalization time(23.39±10.15)d in splenic embolization group was shorter than(31.54±11.08)d in splenectomy group,and median hospitalization expenses 2.77 ten thousand yuan was less than 4.82 ten thousand.Their difference was statistically significant(P<0.05).Before operation,there was no statistically significant difference in levels of WBC,RBC and PLT between the two groups(P>0.05).The levels of WBC and PLT at 3,7,14 and 21 d after operation in splenic embolization group was lower than those in splenectomy group,and RBC level at 3 d after operation was higher than that in splenectomy group.Their difference was statistically significant(P<0.05).There was no statistically significant difference in RBC level at 3,7,14 and 21 d after operation between the two groups(P>0.05).The incidence of ascites infection,perisplenic abscess,portal vein thrombosis,fever,hepatic encephalopathy,diarrhea were 25.00%,2.17%,0,88.04%,1.09%and 2.17%respectively,which had statistically significant difference compared with 42.79%,0,25.00%,98.08%,19.71%and 0 in splenectomy group(P<0.05).There was no statistically significant difference in incidence of ascites,abdominal pain,atelectasis of left lower lung,pneumonia,abdominal hematoma and others between the two groups(P>0.05).Conclusion Partial splenic artery embolization and splenectomy are both effective methods for the trea

关 键 词：脾功能亢进症 部分脾动脉栓塞 脾切除 肝硬化 脾大 并发症 

分 类 号：R657.6[医药卫生—外科学]