近端脾动脉栓塞术治疗难治性腹水：单中心经验

Proximal splenic artery embolization for treatment of refractory ascites, a single-center experience.

作者信息

Mustafa Abdul Rehman, Atta Raneem, P Goodman Russell, Wu Vincent, Irani Zubin, Zurkiya Omar, Bethea Emily D, Yamada Kei, Wehrenberg-Klee Eric P

机构信息

Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

出版信息

Hepatol Res. 2024 Sep 28. doi: 10.1111/hepr.14116.

DOI:10.1111/hepr.14116

PMID:39340746

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11949852/

Abstract

AIM

Refractory ascites from portal hypertension can be managed with regular large-volume paracentesis (LVP) or transjugular intrahepatic portosystemic shunt (TIPS). Large-volume paracentesis is clinically unsatisfactory and many patients are ineligible or relatively contraindicated for TIPS or Denver shunt. Proximal splenic artery embolization (PSAE) using coils or plugs reduces but does not completely stop splenic arterial inflow, differing from distal splenic artery embolization techniques. By reducing splenic arterial inflow, splenic vein outflow is also decreased, lowering portal pressure and thus treating refractory ascites.

METHODS

In this institutional review board-approved single-center retrospective study, electronic medical records were reviewed to obtain demographics and baseline clinical and laboratory data, paracentesis data before and after PSAE, PSAE procedural details, and follow-up imaging up to 12 months post-PSAE. Mixed-effects models were used for statistical analysis.

RESULTS

Ten patients with LVP-dependent ascites meeting inclusion criteria underwent PSAE for refractory ascites from 2017 to 2024. Prior to PSAE, four patients had TIPS, three had liver transplants, and the remaining three were neither TIPS nor transplant candidates. In the month before PSAE, patients averaged 3.8 ± 1.7 paracentesis sessions, draining a total of 20.84 ± 10.39 L of fluid monthly. Post-PSAE, the number of paracentesis sessions decreased to 2.1 ± 2.7, 1.0 ± 1.7, 0.4 ± 1.1, and 0.0 ± 0.0 at 1, 3, 6, and 12 months, respectively (p = 0.03). Corresponding ascitic volume drained decreased to 8.7 ± 10.3, 2.7 ± 6.4, 2.0 ± 5.4, and 0.0 ± 0.0 L (p = 0.01). Over the 12-month follow-up period, 6 of 10 patients became LVP-independent.

CONCLUSION

Proximal splenic artery embolization can improve refractory ascites in certain patients with portal hypertension, thus providing safe and effective treatment as an alternative to TIPS.

摘要

目的

门静脉高压所致难治性腹水可通过定期大量腹腔穿刺放液（LVP）或经颈静脉肝内门体分流术（TIPS）进行治疗。大量腹腔穿刺放液在临床上并不令人满意，许多患者不符合TIPS或丹佛分流术的条件或相对禁忌。使用线圈或栓塞物进行近端脾动脉栓塞术（PSAE）可减少但不能完全阻止脾动脉血流，这与远端脾动脉栓塞技术不同。通过减少脾动脉血流，脾静脉流出量也会减少，从而降低门静脉压力，进而治疗难治性腹水。

方法

在这项经机构审查委员会批准的单中心回顾性研究中，查阅电子病历以获取人口统计学信息、基线临床和实验室数据、PSAE前后的腹腔穿刺放液数据、PSAE手术细节以及PSAE后长达12个月的随访影像学资料。采用混合效应模型进行统计分析。

结果

2017年至2024年，10例符合纳入标准的依赖LVP的腹水患者因难治性腹水接受了PSAE。在进行PSAE之前，4例患者接受了TIPS，3例患者进行了肝移植，其余3例既不是TIPS候选者也不是肝移植候选者。在PSAE前的一个月，患者平均进行3.8±1.7次腹腔穿刺放液，每月共引流20.84±10.39升液体。PSAE后，腹腔穿刺放液次数在1、3、6和12个月时分别降至2.1±2.7、1.0±1.7、0.4±1.1和0.0±0.0次（p = 0.03）。相应的腹水引流量分别降至8.7±10.3、2.7±6.4、2.0±5.4和0.0±0.0升（p = 0.01）。在12个月的随访期内，10例患者中有6例不再依赖LVP。