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部分脾栓塞术:12个月的血液学效应及并发症

Partial splenic embolization: 12-month hematological effects and complications.

作者信息

Wang Horng-Yuan, Shih Shou-Chuan, Lin Shee-Chan, Chang Wen-Shiung, Wang Tsang-En, Lin Fung J, Yang Fei-Shih

机构信息

Division of Gastroenterology and Hepatology, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan.

出版信息

Hepatogastroenterology. 2008 Sep-Oct;55(86-87):1838-42.

Abstract

BACKGROUND/AIMS: To investigate the hematological effects and immediate postoperative complications of partial splenic embolization (PSE) in patients with liver cirrhosis.

METHODOLOGY

Record of liver cirrhosis patients with thrombocytopenia and leukopenia in whom PSE was performed between June 1995 and June 2005 were reviewed. Peripheral blood counts were evaluated at baseline, at 1 week, and at months 1, 3, 6, and 12 months post-PSE and clinically significant complications were recorded.

RESULTS

In the twenty patients who underwent PSE, significant improvements in thrombocyte and leukocyte levels were noted at all time points compared to baseline levels up to one year following PSE (P<0.01). The complication rate was 100% because all patients experienced fever and abdominal pain. Only 7 patients (35%) experienced additional, mild post-embolization complications, and only 2 (10%) experienced serious complications. The mortality rate in this study was 0%.

CONCLUSIONS

PSE significantly improved thrombocytopenia and leukopenia. These results support the contention that PSE is effective and safe, and should be employed more widely in the management of thrombocytopenia in patients with liver cirrhosis, particularly higher-risk patients that may not be candidates for surgical splenectomy. Further studies evaluating risk factors, criteria for patient selection, and target embolization area are warranted.

摘要

背景/目的:探讨部分脾栓塞术(PSE)对肝硬化患者的血液学影响及术后即刻并发症。

方法

回顾性分析1995年6月至2005年6月期间行PSE治疗的肝硬化伴血小板减少和白细胞减少患者的资料。在基线、PSE术后1周、1、3、6和12个月时评估外周血细胞计数,并记录具有临床意义的并发症。

结果

在接受PSE的20例患者中,与基线水平相比,PSE术后长达1年的所有时间点血小板和白细胞水平均有显著改善(P<0.01)。并发症发生率为100%,因为所有患者均出现发热和腹痛。仅7例患者(35%)出现额外的轻度栓塞后并发症,仅2例(10%)出现严重并发症。本研究中的死亡率为0%。

结论

PSE显著改善了血小板减少和白细胞减少。这些结果支持了PSE有效且安全的观点,应更广泛地应用于肝硬化患者血小板减少的治疗,尤其是那些可能不适合手术脾切除的高危患者。有必要进一步研究评估危险因素、患者选择标准和目标栓塞区域。

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