脾栓塞术治疗肝豆状核变性并发中重度脾功能亢进症患者疗效评价  

Comparison of splenic embolization and splenectomy in the treatment of patients with hepatolenticular degeneration complicated with hypersplenism

作　　者：程晓洁 彭星华[2] 葛海江[1] 程海超 张明 李智峰[2] Cheng Xiaojie;Peng Xinghua;Ge Haijiang(Section One,Department of General Surgery,First Hospital,Handan 056000,Hebei Province,China)

机构地区：[1]河北省邯郸市第一医院普外一科,056000 [2]河北省邯郸市第一医院肝胆外一科,056000 [3]华北理工大学附属医院急诊科

出　　处：《实用肝脏病杂志》2025年第2期250-253,共4页Journal of Practical Hepatology

基　　金：河北省医学科学研究计划项目(编号:20241229)。

摘　　要：目的分析比较脾栓塞术与脾切除术治疗肝豆状核变性(HD)并发中重度脾功能亢进症患者的疗效。方法2020年5月~2023年6月我院收治的HD并发中重度脾功能亢进症患者105例,其中65例接受脾栓塞术治疗,另40例接受脾切除术治疗。术中监测平均动脉压(MAP)、心率(HR)和血氧饱和度(SPO 2),采用ELISA法检测血清皮质醇(COR)、C反应蛋白(CRP)和白细胞介素-6(IL-6)水平。结果脾栓塞术组术中出血量为(4.2±0.6)ml,显著少于脾切除术组【(162.3±54.2)ml,P<0.05】,MAP和HR分别为(84.6±11.8)mmHg和(79.8±7.3)次/min,显著低于脾切除术组【分别为(89.6±8.5)mmHg和(84.2±8.5)次/min,P<0.05】;术后,脾切除术组血清COR和CRP水平分别为(487.8±50.2)nmol/L和(82.4±12.5)mg/L,显著高于脾栓塞组【分别为(370.8±47.3)nmol/L和(48.5±9.2)mg/L,P<0.05】;脾切除术组外周血白细胞和血小板计数分别为(6.9±1.2)×10^(9)/L和(164.5±27.3)×10^(9)/L,显著高于脾栓塞术组【分别为(4.9±1.3)×10^(9)/L和(92.6±26.4)×10^(9)/L,P<0.05】;脾栓塞术后腹痛发生率为12.3%,脾切除术后门静脉血栓发生率为12.5%,但两组并发症发生率比较差异无统计学意义(P>0.05)。结论采取脾切除术治疗HD患者纠正脾功能亢进症的作用比较彻底,但可能引起严重的不良反应,而采取脾栓塞术治疗可能对技术要求比较高,应在精准栓塞和防止腹痛方面下功夫。Objective This study was conducted to compare the clinical efficacy of splenic embolization(SPE)and splenectomy in the treatment of patients with hepatolenticular degeneration(HD)complicated with hypersplenism.Methods 105 HD patients with complicated moderate-to-severe hypersplenism were admitted in our hospital between May 2020 and June 2023,and out of them,the SPE was carried out in 61 patients and splenectomy in 40 patients.The mean arterial pressure(MAP),heart rate(HR)and blood oxygen saturation(SPO 2)were monitored during the operation,and serum cortisol(COR),C reactive protein(CRP)and interleukin-6(IL-6)levels were assayed by ELISA.Results The intraoperative blood loss in patients receiving SPE was(4.2±0.6)ml,much less than[(162.3±54.2)ml,P<0.05],while the MAP and HR were(84.6±11.8)mmHg and(79.8±7.3)beats/min.both significantly lower than[(89.6±8.5)mmHg and(84.2±8.5)beats/min,respectively,P<0.05]in patients receiving splenectomy;after operation,serum COR and CRP levels in patients receiving splenectomy(487.8±50.2)nmol/L and(82.4±12.5)mg/L,much higher than[(370.8±47.3)nmol/L and(48.5±9.2)mg/L,respectively,P<0.05]in patients receiving SPE;the white blood cell and platelet counts in patients receiving splenectomy(6.9±1.2)×10^(9)/L and(164.5±27.3)×10^(9)/L,significantly higher than[(4.9±1.3)×10^(9)/L and(92.6±26.4)×10^(9)/L,respectively,P<0.05]in patients receiving SPE;there was no significant difference respect to post-operational complications between the two groups(P>0.05),although abdominal pain after SPE,and portal thrombosis after splenectomy was common.Conclusion We believe that the splenectomy could ameliorate hypersplenism radically,but it might induce portal thrombosis,which should be carefully managed perioperatively.

关 键 词：肝豆状核变性 脾功能亢进症 脾切除术 脾栓塞术 治疗 

分 类 号：R73[医药卫生—肿瘤]