脾动脉主干栓塞在门脉高压并脾功能亢进治疗中的应用

发布时间：2018-04-05 17:04

本文选题：门脉高压　切入点：脾功能亢进　出处：《青岛大学》2016年硕士论文

【摘要】：目的:探讨脾动脉主干栓塞用于治疗门脉高压并脾功能亢进的临床效果,并对比传统的部分性脾栓塞,总结其优势与不足。方法:自2014年1月起至2015年3月,将于我科就诊手术的26例门脉高并脾功能亢进压患者分为A、B两组,A组18例患者应用不锈钢弹簧圈及可脱离球囊行脾动脉主干栓塞,B组8例患者应用PVA颗粒行部分性脾栓塞。术后均随访半年以上,将A组患者术前术后临床表现、外周血三系变化、脾脏最大径、门脉内径进行对比,观察脾动脉主干栓塞对门脉高压并脾亢的治疗效果;将B组患者术前术后外周血三系变化、门脉内径变化进行对比,观察部分性脾栓塞对于门脉高压并脾功能亢进的治疗效果;将A、B两组患者术后不良反应及并发症、外周血三系变化、门脉内径变化进行对比,比较两种手术方式治疗门脉高压并脾亢的效果差异。结果:A组:该组18例患者中,1例患者术中突发上消化道出血,抢救无效死亡,1例患者术后又转外科行脾切除术+食管胃底静脉结扎,2例患者造影证实为肝动脉-门脉畸形,行畸形血管栓塞治疗后门脉高压缓解。余14例患者行脾动脉主干栓塞术,术后临症状改善,8例患者出血术后即停止,6例仍有少量活动性出血,经内科进一步对症处理后出血停止,随访期间均未再发大出血;14例患者食管胃底静脉曲张缓解,外周血细胞三系升高,脾脏体积减小,差异均具有统计学差异(P≤0.05);术后门脉内径减小,术后1月门脉内径对比术前门脉内径减小,差异具有统计学差异(P≤0.05),但术后3月、6月门脉内径对比术前则无统计学差异。B组:8例患者均成功行部分性脾栓塞术,栓塞面积约1/3,患者术前术后外周血三系不同程度升高,具有统计学差异(P≤0.05),但门脉内径变化无统计学差异(P≥0.05),证明其对门脉高压的缓解效果欠佳。A、B两组对比:A组术后外周血三系变化较B组无统计学差异;A组术后门脉内径减小而B组无变化;A组术后不良反应及并发症发生率小于B组,差异有统计学意义(P≤0.05)。结论:1:脾动脉主干栓塞用于治疗门脉高压并脾功能亢进的效果确切,术后不良反应轻,可快速降低门脉压力,缓解临床症状,尤其适用于一般情况较差的患者。2:部分性脾栓塞可使外周血三系升高,但对降低门脉压力的效果欠佳,与前人研究数据有差异,可能与本组病例数较少有关。3:脾动脉主干栓塞较传统部分性脾栓塞具有一定优势,短期内临床效果明显,但远期效果,尤其是对于长期降低门脉压力的效果尚需更加丰富的临床资料进行论证。
[Abstract]:Objective: To investigate the clinical effect of splenic artery embolization for the treatment of portal hypertension and hypersplenism, partial splenic embolization and compared with the traditional, summarizes its advantages and disadvantages. Methods: from January 2014 to March 2015, in our hospital of surgery of 26 cases of portal vein and spleen function hyperfunction of high pressure patients were divided into A, B two groups, A group of 18 patients using stainless steel coil and detachable balloon for splenic artery embolization, 8 cases in B group by PVA granules for partial splenic embolization. All patients were followed up for more than half a year, the A group before and after surgery in patients with clinical manifestations and changes of three peripheral blood. The maximum diameter of the spleen, the diameter of the portal vein were compared, observation of splenic artery embolization on portal hypertension and hypersplenism treatment; three patients will change B group before and after peripheral blood changes, the diameter of the portal vein were compared to observe partial splenic embolization for portal hypertension and hypersplenism Treatment effect; A, B two groups of patients with postoperative adverse reaction and complications, three changes of peripheral blood, change the diameter of the portal vein were compared, the difference between the two types of surgical treatment of portal hypertension and hypersplenism. Results: A group: the group of 18 patients, 1 sudden hemorrhage of digestive tract in one patient, died, 1 patients after surgical splenectomy + esophageal variceal ligation, 2 cases of patients with hepatic artery angiography of portal vein malformations, for vascular malformation embolization in the treatment of portal hypertension in patients with remission. More than 14 cases of splenic artery embolization, postoperative clinical symptoms improved that is, 8 cases of patients with postoperative bleeding stopped in 6 cases, there is still a small amount of bleeding, the bleeding stopped after the symptomatic treatment, further follow-up, there was no recurrence of bleeding; 14 cases of patients with esophageal and gastric varices remission, the peripheral blood cells of three increased spleen volume decreased, the difference was With statistical difference (P = 0.05); patients with portal vein diameter reduced, postoperative 1 Comparison of preoperative portal vein diameter moongates diameter reduced, a statistically significant difference (P = 0.05), but after March, the 6 moongates diameter compared to preoperative veins there were no significant differences between.B group: 8 cases were successfully performed partial splenic embolization, embolization area of about 1/3, patients with preoperative and postoperative peripheral blood of three lines increased, with statistical difference (P < 0.05), but no significant difference in the diameter of the portal vein (P = 0.05), prove the portal hypertension relieving effect of.A, B between the two groups: A after three changes in peripheral blood than B group showed no significant difference in A group; portal vein diameter reduced while the B group had no change; group A postoperative adverse reaction and complication rate of less than B group, the difference was statistically significant (P = 0.05). Conclusion: 1: splenic artery embolization for the treatment of the door portal hypertension and hypersplenism effect Sure, postoperative adverse reactions, can quickly reduce portal pressure, alleviate the clinical symptoms, especially in patients with poor general condition of.2: partial splenic embolization can make the peripheral blood of three lines increased, but to reduce portal pressure effect is poor, is different from the previous research data, and could this group of cases the number is less about the trunk.3: splenic artery embolization with traditional partial splenic embolization has certain advantages, in the short term clinical effect is obvious, but the long-term effect, especially for the long term reduction of portal pressure effect still need more clinical data for the demonstration.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R657.63

【参考文献】