Department of Radiology B, Gabriel Montpied Hospital, University Hospitals of Clermont-Ferrand, Clermont-Ferrand, France.
Diagn Interv Imaging. 2012 Jan;93(1):30-6. doi: 10.1016/j.diii.2011.11.008. Epub 2011 Dec 27.
The objective of this retrospective study was to analyze the efficacy and morbidity associated with splenic artery embolization for hypersplenism due to portal hypertension (PHT), as a function of the volume of the splenic parenchyma embolized and the type of PHT (due to intrahepatic block or segmental PHT).
This study retrospectively included 17 patients with hypersplenism secondary to PHT (intrahepatic block, n=14; segmental, n=3) treated by splenic artery embolization. The splenic volume embolized was estimated by computed tomography (CT) one month after embolization. A clinical assessment and platelet count took place at 7 days, 1 month and 6 months after the embolization.
In the group with PHT due to intrahepatic block, the mean volume of embolized splenic parenchyma was 63% of the initial volume (range: 30-95%). Six months later, the platelet level had increased by an average of 232%. All patients with fewer than 80,000 platelets/mL at 6 months had an embolization volume less than 50%. In the segmental PHT group, the mean volume of the embolized parenchyma was 62% of the initial volume (range: 20-95%), bleeding symptoms had disappeared in all patients, and the platelet level exceeded 80,000/mL. Six patients (6/17, 35%) had complications, two minor and four major: two splenic abscesses, one respiratory distress with ascites, and one pancreatitis with ascites. Five of the six complications were observed in patients with a volume of embolized splenic parenchyma more than 70%.
Our results show that splenic embolization of more than 50% of the parenchyma is effective in the treatment of hypersplenism due to PHT, but that when the embolized volume exceeds 70%, the procedure is associated with considerable morbidity.
本回顾性研究旨在分析因门静脉高压症（PHT）导致的脾功能亢进行脾动脉栓塞治疗的疗效和发病率，以及脾实质栓塞的体积和 PHT 的类型（肝内型或节段型）之间的关系。
本研究回顾性纳入 17 例因 PHT（肝内型 14 例，节段型 3 例）导致脾功能亢进的患者，行经脾动脉栓塞治疗。栓塞后 1 个月通过计算机断层扫描（CT）评估栓塞的脾脏体积。栓塞后 7 天、1 个月和 6 个月进行临床评估和血小板计数。
在肝内型 PHT 组中，栓塞脾实质的平均体积为初始体积的 63%（范围：30%-95%）。6 个月后，血小板平均增加 232%。所有在 6 个月时血小板计数＜80,000/μL 的患者栓塞体积均＜50%。在节段型 PHT 组中，栓塞脾实质的平均体积为初始体积的 62%（范围：20%-95%），所有患者出血症状均消失，血小板计数＞80,000/μL。17 例患者中有 6 例（6/17，35%）出现并发症，2 例为轻微并发症，4 例为严重并发症：2 例脾脓肿，1 例呼吸困难伴腹水，1 例胰腺炎伴腹水。6 例并发症中有 5 例发生在栓塞的脾实质体积＞70%的患者中。
我们的研究结果表明，栓塞超过 50%的脾实质对于治疗因 PHT 导致的脾功能亢进是有效的，但当栓塞体积超过 70%时，该操作会带来相当大的发病率。
