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

卢昊; 许小亚; 叶进冬; 郭栋; 段留新; 李长政; 刘全达

doi:10.3969/j.issn.1001-5256.2017.11.018

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

DOI: 10.3969/j.issn.1001-5256.2017.11.018

1. 火箭军总医院全军肝胆胃肠病中心
2. 苏州大学
3. 中国人民解放军总医院介入科

基金项目:

北京市首都临床特色应用研究 (Z141107002514110)

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2017-05-13
- 出版日期: 2017-11-20

Clinical effect of modified splenic artery embolization in treatment of hypersplenism and splenic artery steal syndrome due to liver cirrhosis

Institute of Hepatobiliary Gastrointestinal Diseases, General Hospital of the PLA Rocket Force

摘要

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<...
- 肝硬化 /
- 脾动脉盗血 /
- 改良型脾动脉栓塞 /
- 脾功能亢进
Abstract:
Objective To 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.Results Within 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) .Conclusion Modified 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.
- liver cirrhosis /
- splenic artery steal syndrome /
- modified splenic artery embolization /
- hypersplenism

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参考文献(14)

[1]PINTO S, REDDY SN, HORROW MM, et al.Splenic artery syndrome after orthotopic liver transplantation:a review[J].Int JSurg, 2014, 12 (11) :1228-1234.

[2]LIU QD, ZHOU NX, WANG MQ, et al.Splenic artery steal syndrome after liver transplantation[J].Chin J Surg, 2005, 43 (15) :989-990. (in Chinese) 刘全达, 周宁新, 王茂强, 等.肝移植术后脾动脉盗血综合征[J].中华外科杂志, 2005, 43 (15) :989-990.

[3]LIU QD, SONG Y, ZHOU NX.Splenic arterial steal syndrome:a neglected therapeutic target for livel diseases[J].J Clin Hepatol, 2011, 27 (3) :241-244. (in Chinese) 刘全达, 宋扬, 周宁新.脾动脉盗血综合征:一个被忽视的肝病治疗靶点[J].临床肝胆病杂志, 2011, 27 (3) :241-244.

[4]LIU QD, ZHOU NX, SONG Y, et al.The application of occlusive techniques of the splenic artery combined with radiofrequency ablation for hypersplenism due to portal hypertension[J].J Clin Hepatol, 2011, 27 (2) :136-139. (in Chinese) 刘全达, 周宁新, 宋扬, 等.脾动脉阻断技术在射频消融治疗门脉高压性脾功能亢进症中的应用[J].临床肝胆病杂志, 2011, 27 (2) :136-139.

[5]DOKMAK S, AUSSILHOU B, BELGHITI J.Liver transplantation and splenic artery steal syndrome:the diagnosis should be established preoperatively[J].Liver Transpl, 2013, 19 (6) :667-668.

[6]HADDUCK TA, MCWILLIAMS JP.Partial splenic artery embolization in cirrhotic patients[J].World J Radiol, 2014, 6 (5) :160-168.

[7]GARCIA-TSAO G, BOSCH J.Varices and variceal hemorrhage in cirrhosis:a new view of an old problem[J].Clin Gastroenterol Hepatol, 2015, 13 (12) :2109-2117.

[8]LAUTT WW.Mechanism and role of intrinsic regulation of hepatic arterial blood flow:hepatic arterial buffer response[J].Am J Physiol, 1985, 249 (5) :549-556.

[9]LIU Q, MA K, SONG Y, et al.Two-year follow-up of radiofrequency ablation for patients with cirrhotic hypersplenism:Does increased hepatic arterial flow induce liver regeneration?[J].Surgery, 2008, 143 (4) :509-518.

[10]ZENG DB, DAI CZ, LU SC, et al.Abnormal splenic artery diameter/hepatic artery diameter ratio in cirrhosis-induced portal hypertension[J].World J Gastroenterol, 2013, 19 (8) :1292-1298.

[11]KIRNAKE V, ARORA A, GUPTA V, et al.Hemodynamic response to carvedilol is maintained for long periods and leads to better clinical outcome in cirrhosis:a prospective study[J].J Clin Exp Hepatol, 2016, 6 (3) :175-185.

[12]SUN Y, REN TS, ZHAO QC.Analysis of drug use in 537 patients with decompensated liver cirrhosis[J].Trauma Crit Med, 2016, 4 (4) :229-235. (in Chinese) 孙滢, 任天舒, 赵庆春.肝硬化失代偿期537例患者用药分析[J].创伤与急危重病医学, 2016, 4 (4) :229-235.

[13]GU JJ, HE XH, LI WT, et al.Safety and efficacy of splenic artery coil embolization for hypersplenism in liver cirrhosis[J].Acta Radiologica, 2012, 53 (8) :862-867.

[14]PRESSER N, QUINTINI C, TOM C, et al.Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients:A 5-year experience[J].Liver Transpl, 2015, 21 (4) :435-441.

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