Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan.
Department of Diagnostic Radiology, National Hospital Organization Kure Medical Center, Hiroshima, Japan.
Minim Invasive Ther Allied Technol. 2024 Feb;33(1):35-42. doi: 10.1080/13645706.2023.2275652. Epub 2024 Feb 2.
The purpose of this study was to determine the effect of proximal splenic artery embolization (SAE) in cirrhotic patients with splenomegaly who underwent surgical laparotomy.
This retrospective observational study included 8 cirrhotic patients with splenomegaly. They underwent proximal SAE before- ( = 6) or after ( = 2) laparotomy. Vascular plugs or coils were placed in the proximal splenic artery. The diameter of the portal vein and the splenic volume were recorded. Clinical outcome assessments included platelet counts, the model for end-stage liver disease (MELD) score, and complications.
After embolization, the portal venous diameter was significantly smaller (pre: 13.6 ± 2.7 mm, post: 12.5 ± 2.3 mm, = 0.023), the splenic volume was significantly decreased (pre: 463.2 ± 145.7 ml, post: 373.3 ± 108.5 ml, = 0.008) and the platelet count was significantly higher (pre: 69.6 ± 30.8 × 10μl, post: 86.8 ± 27.7 × 10μl, = 0.035). Before embolization, the median MELD score was 12; after embolization, it was 11 ( = 0.026). No patient developed post-treatment complications after embolization.
The reduction of hypersplenism by perioperative proximal SAE may be safe and reduce the surgical risk in cirrhotic patients with splenomegaly.
本研究旨在探讨脾切除术前行或术后行脾动脉近端栓塞术（SAE）对肝硬化脾肿大患者的影响。
本回顾性观察性研究纳入 8 例肝硬化脾肿大患者。其中 6 例在脾切除术前行近端 SAE，2 例在脾切除术后行近端 SAE。采用血管塞或线圈栓塞脾动脉近端。记录门静脉直径和脾脏体积。临床结局评估包括血小板计数、终末期肝病模型（MELD）评分和并发症。
栓塞后，门静脉直径明显减小（术前：13.6±2.7mm，术后：12.5±2.3mm， = 0.023），脾脏体积明显减小（术前：463.2±145.7ml，术后：373.3±108.5ml， = 0.008），血小板计数明显升高（术前：69.6±30.8×10μl，术后：86.8±27.7×10μl， = 0.035）。栓塞前 MELD 评分为中位数 12；栓塞后为 11（ = 0.026）。栓塞后无患者发生治疗后并发症。
围手术期脾动脉近端栓塞术可减少脾功能亢进，可能安全且降低肝硬化脾肿大患者的手术风险。
