脾动脉非选择性与高选择性插管后部分脾栓塞术在肝硬化继发脾功能亢进患者中的对比研究  

Non-selective versus highly selective partial splenic embolization in treating patients with hypersplenism secondary to liver cirrhosis: a comparative study

作　　者：谢青云[1] 高峰畏 雷泽华[1] 蒋康怡 龚杰 赵欣 Xie Qingyun;Gao Fengwei;Lei Zehua;Jiang Kangyi;Gong Jie;Zhao Xin(Department of Hepatobiliary Pancreatic Surgery,Leshan People's Hospital(Leshan Diagnosis and Treatment Center for Systemic Disease),Leshan 614000,Sichuan Province,China)

机构地区：[1]乐山市人民医院肝胆胰外科(乐山市肝胆胰脾系统性疾病诊疗中心),四川乐山614000

出　　处：《中华肝胆外科杂志》2021年第12期917-922,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：四川省卫生健康委科研项目(20PJ296)。

摘　　要：目的对比探讨非选择性与高选择性插管后部分脾栓塞术在肝硬化继发脾功能亢进患者中的临床应用效果。方法回顾性分析2017年7月至2020年7月在乐山市人民医院肝胆胰外科接受部分脾栓塞术治疗的乙型肝炎肝硬化继发脾功能亢进患者的临床资料。共入选脾功能亢进患者65例,其中男性42例,女性23例,年龄(58.5±9.8)岁。65例患者中,26例行脾动脉非选择性部分脾栓塞术(非选择组),39例行高选择性插管后部分脾栓塞术(高选择组)。对比分析两组患者的术后外周血液学指标、肝功能、手术相关并发症、门静脉彩色多普勒超声检查等情况。结果两组患者术后的白细胞计数和血小板计数均较术前升高,高选择组在术后4、12和24周时的白细胞计数以及12和24周时的血小板计数均高于非选择组,差异均具有统计学意义(P<0.05)。术后第12和24周,高选择组的总胆红素、吲哚菁绿15 min滞留率、门静脉内径和门静脉血流量均较非选择组降低,差异具有统计学意义(P<0.05)。非选择组与高选择组患者0/Ⅰ/Ⅱ/Ⅲ级疼痛发生率间比较(5/10/11/1比12/22/7/0例),差异具有统计学意义(P<0.05),两组其余术后并发症发生率间比较差异无统计学(P>0.05)。结论高选择性部分脾栓塞术治疗肝硬化所致脾功能亢进较非选择性部分脾栓塞术的临床疗效更稳定、持久,更能促进机体血液相关指标恢复,更有利于术后肝功能的改善以及门静脉高压症状的缓解。ObjectiveTo compare the clinical outcomes of treatment using non-selective versus highly selective partial splenic embolization in patients with hypersplenism secondary to liver cirrhosis.MethodsThe clinical data of patients with hypersplenism secondary to hepatitis B cirrhosis who underwent splenic embolization at the Department of Hepatobiliary and Pancreatic Surgery of Leshan People's Hospital from July 2017 to July 2020 were analyzed retrospectively.Of 65 patients with hypersplenism,there were 42 males and 23 females,with age of(58.5±9.8)years.Twenty-six patients underwent splenic artery non-selective partial splenic embolization(the non-selective group)and 39 patients underwent partial splenic embolization using highly selective intubation(the highly selective group).The postoperative peripheral hematological indexes,liver function,operation-related complications and portal vein color Doppler ultrasonography were compared between the two groups.ResultsThe white blood cell count and platelet count of patients in the 2 groups were significantly higher than those before operation.The white blood cell count at 4,12 and 24 weeks after operation and the platelet count at 12 and 24 weeks after operation in the highly selective group were significantly higher than those in the non-selective group(P<0.05).Compared with the non-selective group,the total bilirubin,ICG-R15,portal vein diameter and portal vein blood flow in the highly-selective group significantly lower(P<0.05).The incidences of 0/Ⅰ/Ⅱ/Ⅲpain in the non-selected group was significantly higher when compared with that in the highly selected group(5/10/11/1 vs.12/22/7/0),(P<0.05).There were no significant differences in the incidences of postoperative complication between the two groups(P>0.05).ConclusionCompared with non-selective partial splenic embolization,highly selective partial splenic embolization gave more stable and lasting treatment outcomes in patients with hypersplenism caused by liver cirrhosis with better recovery of blood-related indica

关 键 词：脾功能亢进 肝硬化 栓塞治疗 

分 类 号：R575.2[医药卫生—消化系统] R551.1[医药卫生—内科学]