TIPS与PSE术治疗乙型肝炎肝硬化并发脾功能亢进症患者疗效研究  

Improvement of hypersplenism in patients hepatitis B cirrhosis after TIPS and PSE combination treatment

作　　者：周秋娟 朱逸明 马宇航 陈婷闪 Zhou Qiujuan;Zhu Yiming;Ma Yuhang(Department of Radiology,Integrated Traditional Chinese and Western Medicine Hospital,Suzhou 215101,Jiangsu Province,China)

机构地区：[1]苏州市中西医结合医院影像科,江苏省215101 [2]苏州市中西医结合医院介入科 [3]南京医科大学附属淮安第一医院影像科,江苏省215101

出　　处：《实用肝脏病杂志》2023年第2期266-269,共4页Journal of Practical Hepatology

基　　金：江苏省自然科学基金资助项目(编号:BK20181174)。

摘　　要：目的 研究经颈静脉肝内门体静脉分流术(TIPS)联合部分脾动脉栓塞术(PSE)治疗乙型肝炎肝硬化并发脾功能亢进症患者的疗效。方法 2018年1月~2021年1月我院诊治的乙型肝炎肝硬化并发脾功能亢进症患者72例,随机分为PSE治疗组36例和联合组36例,分别行PSE治疗或PSE联合TIPS术治疗,随访1年。结果 在治疗后1 w,联合组外周血PLT和WBC计数分别为(76.1±25.8)×109/L和(4.2±1.2)×109/L,显著高于PSE治疗组【分别为(45.8±13.7)×109/L和(2.4±0.5)×109/L,P<0.05】;在治疗后12 m,联合组外周血PLT和WBC计数分别为(59.3±18.7)×109/L和(2.8±0.9)×109/L,显著高于PSE治疗组【分别为(45.6±14.2)×109/L和(2.0±0.6)×109/L,P<0.05】;联合组血清白蛋白水平为(37.9±3.4)g/L,显著高于PSE治疗组【(35.9±3.5)g/L,P<0.05】。术后,联合组支架狭窄和肝性脑病发生率分别为22.2%和33.3%。结论 采用TIPS联合PSE术治疗乙型肝炎肝硬化并发脾功能亢进症患者有利于提示血细胞数,可能对防止感染有帮助。Objective The purpose of this study was to observe the efficacy of transjugular intrahepatic portal shunt(TIPS) and partial splenic artery embolization(PSE) in the treatment of patients with hepatitis B cirrhosis complicated by hypersplenism. Methods A total of 72 patients with hepatitis B cirrhosis complicated by hypersplenism were encountered in our hospital between January 2018 and January 2021, and were randomly divided into control(n = 36) and combination group(n = 36), receiving PSE or PSE and TIPS combination treatment. All patients were followed-up for one year. Results One week after treatment, the platelet(PLT) and white blood cell(WBC) counts in the combination group were(76.1±25.8) ×10~9/L and(4.2±1.2) ×10~9/L, both significantly higher than [(45.8±13.7) ×10~9/L and(2.4±0.5) ×10~9/L, respectively, P < 0.05] in PSE-treated patients;at the end of 12 months after operation, the PLT and WBC counts in the combination group were(59.3±18.7) ×10~9/L and(2.8±0.9) ×10~9/L, both significantly higher than [(45.6±14.2) ×10~9/L and(2.0±0.6) ×10~9/L, respectively, P<0.05] in the PSE-treated patients;serum albumin level in the combination group were(37.9±3.4) g/L, significantly higher than [(35.9±3.5) g/L, P < 0.05] in PSE-treated patients;the incidences of stent stenosis and hepatic encephalophathy after TIPS and PSE were 22.2% and 33.3%. Conclusion The TIPS and PSE is beneficial to alleviate short-term postoperative hypersplenism in patients with hepatitis B liver cirrhosis, which might help improve the compromised functions of immune system.

关 键 词：肝硬化 脾功能亢进症 经颈静脉肝内门体静脉分流术 部分脾动脉栓塞术 治疗 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学] R551.1