首 页   本刊简介  编委会  审稿专家  在线期刊  写作规范  广告合作  联系我们
您现在的位置:首页 => 在线期刊 => 11期原发性胆汁性胆管炎 => 肝纤维化及肝硬化 =>改良脾动脉栓塞治疗肝硬化性脾..
改良脾动脉栓塞治疗肝硬化性脾功能亢进 及脾动脉盗血综合征的临床效果
Clinical effect of modified splenic artery embolization in treatment of hypersplenism and splenic artery steal syndrome due to liver cirrhosis
文章发布日期:2017年10月11日  来源:  作者:卢昊,许小亚,叶进冬,等  点击次数:117次  下载次数:23次

调整字体大小:

(此处下载失败可以在在线预览处保存副本或者右键另存为)

【摘要】:目的肝硬化合并脾功能亢进患者的粗大脾动脉竞争性“窃取”腹腔干血流,引起肝动脉灌注不足(即肝硬化性脾动脉盗血综合征)。探讨脾动脉主干联合分支动脉栓塞的改良脾动脉栓塞术纠正肝硬化性脾动脉盗血综合征及脾功能亢进的有效性。方法选取2007年1月-2015年12月在火箭军总医院和解放军总医院住院的脾功能亢进合并脾动脉盗血综合征的肝硬化患者220例,分成3组,即给予药物或联合内镜干预的内科治疗组(120例)、内科治疗基础上实施传统的部分脾栓塞组(PSE组,40例)和联合脾动脉主干及分支动脉栓塞的改良脾动脉栓塞组(MSAE组,60例),中位随访5年以上,并对3组间的相关指标进行比较分析。计量资料3组间比较利用单因素方差分析,进一步两两比较采用LSD-t检验;2组间比较采用t检验;计数资料组间比较采用χ2检验;利用Kaplan-Meier生存分析法分析生存率和消化道出血率;log-rank法检验统计学差异。结果MSAE组患者血小板、白细胞计数术后5年内整体水平显著高于内科治疗组(P值均<0.05)。术后6个月MSAE组Child-Pugh评分显著低于内科治疗组(P<0001)和PSE组(P=0.014);术后1年MSAE组Child-Pugh评分仍显著低于内科治疗组(P=0.009);术后6个月MSAE组MELD评分显著低于内科治疗组(P=0.004)和PSE组(P=0.048);术后1年MSAE组MELD评分仍显著低于内科治疗组(P=0012)。MSAE组消化道出血/再出血及内镜治疗次数显著低于PSE组和内科治疗组(χ2=9.41,P=0.009;χ2=10.91,P=0004);术后5年MSAE组术后消化道出血/再出血发生率仍显著低于内科治疗组(χ2=14.70,P=0.002)。MASE组术后并发症(发热、腹痛)程度及持续时间均有所改善,脾脓肿等严重并发症发生率更低。MSAE组中位生存时间45(8~91)个月,PSE组中位生存时间41(6~86)个月,内科治疗组中位生存时间34.5(7~84)个月。随访5年MSAE组死亡7例(11.7%),内科治疗组死亡40例(30%),PSE组死亡7例(175%)。MSAE组患者累积生存率显著高于内科治疗组(χ2=9.733,P=0.001)。结论联合脾动脉主干及分支动脉栓塞的改良型脾动脉栓塞术安全性较高,能有效纠正肝硬化性脾功能亢进和脾动脉盗血,且能改善肝功能,一定程度降低消化道出血风险,值得进一步深入研究。
【Abstract】:ObjectiveTo investigate the clinical effect of modified splenic artery embolization of the splenic artery and branch arteries in the treatment of splenic artery steal syndrome (SASS) and hypersplenism due to liver cirrhosis, since in patients with liver cirrhosis complicated by hypersplenism, the enlarged splenic artery competitively “steals” the blood flow in the celiac trunk and causes hypoperfusion in the hepatic artery (i.e., SASS due to liver cirrhosis). Methods A total of 220 cirrhotic patients with hypersplenism and SASS who were hospitalized in General Hospital of the PLA Rocket Force and Chinese PLA General Hospital from January 2007 to December 2015 were enrolled and divided into medical treatment group with 120 patients (drugs combined with endoscopic intervention), partial splenic embolization (PSE) with 40 patients (PSE combined with medical treatment), and modified splenic artery embolization (MSAE) group with 60 patients (embolization of the splenic artery and branch arteries combined with medical treatment). Related indices were analyzed and compared between the three groups. A one-way analysis of variance was used for comparison of continuous data between three groups, and the least significant difference t-test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups; the Kaplan-Meier survival analysis was used to calculate survival rates and gastrointestinal bleeding rate; the log-rank test was used to evaluate statistical difference. ResultsWithin 5 years after surgery, the MSAE group had significantly higher platelet and leukocyte counts than the medical treatment group (P<0.05). At 6 months after surgery, the MSAE group had a significantly lower Child-Pugh score than the medical treatment group (P<0.001) and the PSE group (P=0.014); at 1 year after surgery, the MSAE group still had a significantly lower Child-Pugh score than the medical treatment group (P=0.009). At 6 months after surgery, the MSAE group had a significantly lower Model for End-Stage Liver Disease (MELD) score than the medical treatment group (P=0.004) and the PSE group (P=0.048); at 1 year after surgery, the MSAE group still had a significantly lower MELD score than the medical treatment group (P=0.012). The MSAE group had significantly lower numbers of gastrointestinal bleeding/rebleeding events and endoscopic therapies than the PSE group (χ2=9.41, P=0.009) and the medical treatment group (χ2=10.91, P=0.004); at 5 years after surgery, the MSAE group still had a significantly lower incidence rate of gastrointestinal bleeding/rebleeding than the medical treatment group (χ2=14.70, P=0002). The MSAE group had certain improvements in the degree and duration of postoperative complications (pyrexia and abdominal pain) and had a lower incidence rate of serious complications (splenic abscess), as compared with the other two groups. The median survival time was 45 (8-91) months in the MSAE group, 41 (6-86) months in the PSE group, and 34.5 (7-84) months in the medical treatment group. During the 5-year follow-up, 7 patients (11.7%) in the MSAE group, 40 (30%) in the medical treatment group, and 7(175%) in the PSE group died. The MSAE group had a significantly higher cumulative survival rate than the medical treatment group (χ2=9733, P=0001). ConclusionModified splenic artery embolization of the splenic artery and branch arteries has good safety and can effectively correct hypersplenism and SASS due to liver cirrhosis, improve liver function, and reduce the risk of gastrointestinal bleeding. Therefore, it deserves further investigation.
【关键字】:肝硬化; 脾动脉盗血; 改良型脾动脉栓塞; 脾功能亢进
【Key words】:liver cirrhosis; splenic artery steal syndrome; modified splenic artery embolization; hypersplenism
【引证本文】:卢昊, 许小亚,叶进冬,等. 改良脾动脉栓塞治疗肝硬化性脾功能亢进及脾动脉盗血综合征的临床效果[J]. 临床肝胆病杂志, 2017, 33(11): 2141-2146.

地址:长春市东民主大街519号《临床肝胆病杂志》编辑部 邮编:130061 电话:0431-88782542/3542
临床肝胆病杂志 版权所有 Copyright © 2009 - 2013 Lcgdbzz.org. All Rights Reserv 吉ICP备10000617号

吉公网安备 22010402000041号