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目的探讨不同栓塞材料在肝硬化合并脾功能亢进部分性脾栓塞术(PSE)中的临床应用。方法32例肝硬化并脾功能亢进患者行PSE治疗,根据栓塞材料的不同分为3组:A组12例,采用00000手术丝线制成的丝线线段;B组10例,采用300~500μm聚乙烯泡沫醇(PVA)颗粒;C组10例,采用明胶海绵颗粒。比较3组PSE术前及术后24h、3d、7d、1个月和3个月各时间段外周血细胞计数的变化,并观察各组术后反应及并发症发生情况。结果各组PSE术后24h、3d、7d、1个月和3个月外周血WBC和血小板(PLT)计数均较术前升高(P<0.05),B组和C组比A组上升稍多,但在同一时间段3组之间并无显著性差异(P>0.05)。外周血RBC和Hb的变化不明显(P>0.05)。术后B组较A组和C组疼痛程度重,持续时间长(P<0.05)。A组的较严重并发症的发生率比B和C组低。结论采用丝线线段治疗肝硬化合并脾功能亢进相对更安全可靠。
Objective To investigate the clinical application of different embolic materials in partial splenic embolization (PSE) with cirrhosis and hypersplenism. Methods Thirty-two patients with liver cirrhosis and hypersplenism underwent PSE. According to different embolization materials, the patients were divided into three groups: group A (12 cases), line 00000 surgical filaments; group B (10 cases) Foam alcohol (PVA) particles; C group of 10 cases, the use of gelatin sponge particles. The changes of peripheral blood cell counts in preoperative and postoperative 24h, 3d, 7d, 1 and 3 months after operation were compared, and the postoperative response and complications were observed. Results The counts of peripheral blood WBC and PLT in PSE group were significantly higher than those before operation (P <0.05) at 24 h, 3 d, 7 d, 1 month and 3 months after PSE, while those in group B and C were slightly higher than those in group A However, there was no significant difference between the three groups at the same time (P> 0.05). The changes of peripheral blood RBC and Hb were not significant (P> 0.05). Postoperative B group than the A and C group, the severity of pain, longer duration (P <0.05). The incidence of more serious complications in group A was lower than in groups B and C. Conclusion The treatment of cirrhosis complicated with hypersplenism by silk thread is relatively safe and reliable.