Sangro B, Bilbao I, Herrero I, Corella C, Longo J, Beloqui O, Ruiz J, Zozaya J M, Quiroga J, Prieto J
Department of Medicine, Universidad de Navarra, Pamplona, Spain.
Hepatology. 1993 Aug;18(2):309-14.
Hypersplenism is of great relevance in the management of cirrhosis because of the widespread use of myelodepressant drugs such as interferon or antineoplastic agents. Because no standard therapy exists for this complication, we have evaluated the efficacy and risks of splenic embolization in the treatment of hypersplenism in cirrhosis. Partial splenic embolization was performed in 40 consecutive patients with the following indications: 25 patients with active viral cirrhosis before interferon therapy, 8 patients with unresectable hepatocellular carcinoma before anti-neoplastic chemotherapy and 7 patients with thrombocytopenia associated with spontaneous bleeding events, with high risk of central nervous system hemorrhage or facing major surgery. After selective catheterization of the splenic artery, partial splenic embolization was performed by means of repeated injections of gelatin sponge until a 40% to 60% reduction in the splenic blood flow was achieved. After partial splenic embolization a significant and sustained increase in platelet and white blood cell count was observed during the follow-up period (mean = 13.9 +/- 2.2 mo; range = 1 to 36 mo). The goal of partial splenic embolization was achieved in all but two patients in whom a dose reduction of interferon was needed. Hypersplenism relapsed in only seven patients, and all of them exhibited an embolization of less than 50% of the splenic mass. Postembolization syndrome was the main side effect, but no life-threatening complications were detected. In conclusion, partial splenic embolization is a safe and effective therapy of hypersplenism in cirrhosis.
由于干扰素或抗肿瘤药物等骨髓抑制药物的广泛使用，脾功能亢进在肝硬化的治疗中具有重要意义。由于目前尚无针对该并发症的标准治疗方法，我们评估了脾栓塞术治疗肝硬化脾功能亢进的疗效和风险。对40例连续患者进行了部分脾栓塞术，其适应证如下：25例为干扰素治疗前的活动性病毒性肝硬化患者，8例为抗肿瘤化疗前无法切除的肝细胞癌患者，7例为与自发性出血事件相关的血小板减少患者，这些患者存在中枢神经系统出血的高风险或面临大手术。在选择性脾动脉插管后，通过反复注射明胶海绵进行部分脾栓塞术，直至脾血流量减少40%至60%。部分脾栓塞术后，随访期间观察到血小板和白细胞计数显著且持续升高（平均 = 13.9 +/- 2.2个月；范围 = 1至36个月）。除两名需要减少干扰素剂量的患者外，所有患者均达到了部分脾栓塞的目标。仅7例患者脾功能亢进复发，且所有复发患者的脾栓塞面积均小于50%。栓塞后综合征是主要的副作用，但未检测到危及生命的并发症。总之，部分脾栓塞术是治疗肝硬化脾功能亢进的一种安全有效的方法。
