Zhu Kangshun, Meng Xiaochun, Li Zhengran, Huang Mingsheng, Guan Shouhai, Jiang Zaibo, Shan Hong
Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong Province 510630, China.
Eur J Radiol. 2008 Apr;66(1):100-6. doi: 10.1016/j.ejrad.2007.04.010. Epub 2007 May 25.
To prospectively evaluate the efficacy and safety of partial splenic embolization (PSE) using polyvinyl alcohol (PVA) particles for hypersplenism in cirrhosis, as compared to PSE using gelfoam particles.
PSE was performed in 60 consecutive patients with hypersplenism caused by cirrhosis. The patients were randomly assigned into 2 groups: gelfoam group, 32 patients received PSE using gelfoam particles as the embolic material; PVA group, 28 patients received PSE using PVA particles. The follow-up contents included peripheral blood cell counts (leukocyte, platelet and red blood cell) and complications associated with PSE.
Prior to PSE, there was no significant difference between the two groups in sex, age, Child-Pugh grade, the extent of embolization and peripheral blood cell counts. After PSE, no matter in which group, leukocyte and platelet counts kept significantly higher than pre-PSE during the 3-year follow-up period (P<.0001), but the post-PSE improvement of leukocyte and platelet counts was significantly better in PVA group than in gelfoam group (P<.05). Red blood cell counts showed no remarkable changes after PSE (P>.05). Severe complications occurred in 8 patients (25.0%) in gelfoam group and 6 patients (21.4%) in PVA group (P>.05), but the degree of abdominal pain was higher in the latter than in the former (P<.05). Among 17 patients who received more than 70% embolization of spleen, 10 (58.8%) developed severe complications, while among 43 patients who received 70% or less embolization of spleen, only four (9.3%) had severe complications. This difference was statistically significant (P<.05).
PVA particles could be used as the embolic material in PSE; in comparison with PSE using gelfoam particles, PSE using PVA particles can achieve even better efficacy in alleviating hypersplenism, but the extent of embolization should be strictly limited to not more than 70% of splenic volume.
前瞻性评估使用聚乙烯醇（PVA）颗粒进行部分脾栓塞术（PSE）治疗肝硬化脾功能亢进的疗效和安全性，并与使用明胶海绵颗粒进行的PSE作比较。
对60例连续性肝硬化所致脾功能亢进患者进行PSE。患者随机分为2组：明胶海绵组，32例患者使用明胶海绵颗粒作为栓塞材料进行PSE；PVA组，28例患者使用PVA颗粒进行PSE。随访内容包括外周血细胞计数（白细胞、血小板和红细胞）以及与PSE相关的并发症。
PSE术前，两组在性别、年龄、Child-Pugh分级、栓塞范围和外周血细胞计数方面无显著差异。PSE术后，在3年随访期内，无论哪一组，白细胞和血小板计数均显著高于PSE术前（P<0.0001），但PVA组白细胞和血小板计数的术后改善情况显著优于明胶海绵组（P<0.05）。PSE术后红细胞计数无明显变化（P>0.05）。明胶海绵组8例患者（25.0%）发生严重并发症，PVA组6例患者（21.4%）发生严重并发症（P>0.05），但PVA组腹痛程度高于明胶海绵组（P<0.05）。在17例脾栓塞超过70%的患者中，10例（58.8%）发生严重并发症，而在43例脾栓塞70%及以下的患者中，仅有4例（9.3%）发生严重并发症。这种差异具有统计学意义（P<0.05）。
PVA颗粒可作为PSE的栓塞材料；与使用明胶海绵颗粒进行的PSE相比，使用PVA颗粒进行的PSE在缓解脾功能亢进方面疗效更佳，但栓塞范围应严格限制在脾体积的70%以内。
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