Rabczyński Maciej, Fenc Monika, Dybko Jarosław, Garcarek Jerzy, Miś Marcin, Guziński Maciej
Department of Angiology, Hypertension, and Diabetology, Wroclaw Medical University, Wroclaw, Poland.
Department of Hematology and Cellular Transplantation, Lower Silesian Oncology Center, Wroclaw, Poland.
Pol J Radiol. 2022 Jul 6;87:e369-e374. doi: 10.5114/pjr.2022.118159. eCollection 2022.
Partial splenic endovascular embolization (PSEE) could be an option for patients with thrombocytopaenia (TCP). We selected a group of 22 patients diagnosed with refractory TCP to undergo PSEE, and we followed them for detailed analysis.
Twenty-two patients aged 27-75 years (mean 46.5 ± 3.5 years) underwent PSEE, and 5 participants underwent a second PSEE due to the lack of effectiveness after the first procedure. A total of 27 PSEEs were performed. A semi-quantitative scale was used to assess the severity of the post-embolization syndrome. The percentage of spleen parenchyma excluded from circulation was 30-70%. We used the mixture of Histoacryl N-butyl cyanoacry-late glue and Lipiodol in 10 cases, spirals in 10 cases, and polyvinyl alcohol in 7 cases, for the embolization.
The mean value of platelet count (PLT) before procedure increased from 22.0 ± 15.0 to 87.7 ± 67.9 ( < 0.05) in a mean period of 194 days. In 2 cases severe post-embolization syndrome was observed. Closure less than 50% of the spleen circulation was associated with poorly expressed post-embolization symptoms. Serious complications occurred in 1 patient (3.5%). A strong positive correlation ( = 0.8, < 0.05) was found between C-reactive protein (CRP) and the severity of post-embolization syndrome. Increased symptoms of post-embolization syndrome were also associated with a significant increase in hospitalization time - 27.0 vs. 7.2 days ( = 0.66, < 0.05).
Partial endovascular embolization of the spleen (PSEE) may be a valuable therapeutic option for patients with refractory TCP. PSEE is a safe method with a low complication rate.
部分脾血管内栓塞术（PSEE）可能是血小板减少症（TCP）患者的一种治疗选择。我们选取了一组22例诊断为难治性TCP的患者进行PSEE，并对他们进行随访以进行详细分析。
22例年龄在27 - 75岁（平均46.5±3.5岁）的患者接受了PSEE，其中5例患者因首次手术后效果不佳而接受了第二次PSEE。共进行了27次PSEE。使用半定量量表评估栓塞后综合征的严重程度。脾实质被排除在循环之外的比例为30% - 70%。栓塞时，10例使用了Histoacryl正丁基氰基丙烯酸酯胶与碘油的混合物，10例使用了弹簧圈，7例使用了聚乙烯醇。
术前血小板计数（PLT）的平均值在平均194天内从22.0±15.0升至87.7±67.9（P<0.05）。观察到2例严重的栓塞后综合征。脾循环封闭小于50%与栓塞后症状表现不明显相关。1例患者（3.5%）发生了严重并发症。发现C反应蛋白（CRP）与栓塞后综合征的严重程度之间存在强正相关（r = 0.8，P<0.05）。栓塞后综合征症状的加重也与住院时间显著延长相关——分别为27.0天和7.2天（P = 0.66，P<0.05）。
脾部分血管内栓塞术（PSEE）可能是难治性TCP患者的一种有价值的治疗选择。PSEE是一种安全的方法，并发症发生率低。
