Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
BMC Gastroenterol. 2022 Nov 19;22(1):470. doi: 10.1186/s12876-022-02580-8.
The aim of this study was to investigate the efficacy and safety of the combination of low-molecular-weight heparin + dexamethasone after partial splenic embolization in cirrhotic patients with massive splenomegaly.
This study included 116 patients with liver cirrhosis complicated with massive splenomegaly who underwent PSE in Union Hospital from January 2016 to December 2019, and they met the criteria. They were divided into two groups: PSE + Hep + Dex group (N = 54) and PSE group (N = 62). We conducted a retrospective study to analyze the efficacy and safety of the two groups of patients.
The volume of splenic embolization was 622.34 ± 157.06 cm in the PSE + Hep + DEX group and 587.62 ± 175.33 cm in the PSE group (P = 0.306). There was no statistically difference in the embolization rate of the spleen between the two groups (P = 0.573). WBC peaked 1 week after PSE and PLT peaked 1 month after PSE in both groups; it gradually decreased later, but was significantly higher than the preoperative level during the 12-month follow-up period. The incidences of abdominal pain (46.3% vs 66.1%, P = 0.039), fever (38.9% vs 75.8%, P < 0.001), PVT (1.9% vs 12.9%, P = 0.026), refractory ascites (5.6% vs 19.4%, P = 0.027) were lower in the PSE + Hep + DEX group than in the PSE group. The VAS score of abdominal pain in PSE group was higher than that in PSE + Hep + DEX group on postoperative days 2-8 (P < 0.05). Splenic abscess occurred in 1(1.6%) patient in the PSE group and none (0.0%) in the PSE + Hep + DEX group (P = 0.349).
The combined use of dexamethasone and low-molecular-weight heparin after PSE is a safe and effective treatment strategy that can significantly reduce the incidence of complications after PSE (such as post-embolization syndrome, PVT, refractory ascites).
本研究旨在探讨低分子肝素联合地塞米松在接受部分性脾动脉栓塞术（PSE）治疗的肝硬化大量脾肿大患者中的疗效和安全性。
本研究纳入了 2016 年 1 月至 2019 年 12 月期间在协和医院接受 PSE 治疗的 116 例肝硬化伴大量脾肿大患者，符合纳入标准。将患者分为两组：PSE+肝素+地塞米松组（PSE+Hep+Dex 组，N=54）和 PSE 组（PSE 组，N=62）。我们进行了一项回顾性研究，分析两组患者的疗效和安全性。
PSE+Hep+DEX 组的脾栓塞体积为 622.34±157.06cm³，PSE 组为 587.62±175.33cm³（P=0.306）。两组的脾脏栓塞率无统计学差异（P=0.573）。两组患者的白细胞计数均在 PSE 后 1 周达到峰值，血小板计数在 PSE 后 1 个月达到峰值，之后逐渐下降，但在 12 个月的随访期间，均显著高于术前水平。腹痛发生率（46.3% vs 66.1%，P=0.039）、发热发生率（38.9% vs 75.8%，P<0.001）、门静脉血栓形成发生率（1.9% vs 12.9%，P=0.026）、难治性腹水发生率（5.6% vs 19.4%，P=0.027）均低于 PSE 组。PSE 组患者术后第 2-8 天的腹痛视觉模拟评分（VAS）高于 PSE+Hep+DEX 组（P<0.05）。PSE 组发生脾脓肿 1 例（1.6%），PSE+Hep+DEX 组无脾脓肿（0.0%）（P=0.349）。
PSE 后联合应用地塞米松和低分子肝素是一种安全有效的治疗策略，可显著降低 PSE 后并发症的发生率（如栓塞后综合征、门静脉血栓形成、难治性腹水）。
