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目的探讨超选择性脾中下叶动脉栓塞术在晚期血吸虫肝病所致脾功能亢进的临床应用价值。方法分析38例晚期血吸虫肝病合并巨脾患者,均经CT和/或MRI检查结合临床表现诊断为重度脾功能亢进。超选择性置管于脾中下叶动脉内行介入栓塞处理(n=20),常规置管于脾动脉主干末端、采用低压流控法行栓塞脾脏外周组织(n=18)。结果 38例均成功栓塞,成功率100%。对于纠正脾功能亢进,改善外周血红蛋白、白细胞和血小板均有明显的疗效,统计学上无明显差异(P>0.05)。脾中下极动脉栓塞法能准确控制栓塞部位和面积,栓塞术后综合征和术后其他并发症明显减轻,特别是对肺部、胸腔、左膈的影响较小,便于患者术后尽快恢复。结论晚期血吸虫肝病所致脾功能亢进采取超选择性插管入脾中下极动脉后行栓塞治疗临床效果理想,并发症发生率较脾动脉主干末端行栓塞治疗明显降低,不适反应程度轻,患者恢复快,住院时间短。
Objective To investigate the clinical value of superselective splenic artery embolization in hypersplenism induced by liver disease of advanced schistosomiasis. Methods 38 cases of advanced schistosomiasis liver disease combined with splenomegaly were diagnosed as severe hypersplenism by CT and / or MRI combined with clinical manifestations. Superselective catheterization was performed in the lower lobe arteries in the spleen by interventional embolization (n = 20). Conventional catheterization was performed at the distal end of the splenic artery. Peripheral tissue of the spleen was occluded with low pressure fluidics (n = 18). Results 38 cases were successful embolization, the success rate of 100%. For the correction of hypersplenism and improve the peripheral hemoglobin, white blood cells and platelets have a significant effect, no statistically significant difference (P> 0.05). Splenic inferior polar artery embolization method can accurately control the embolization site and area, post-embolization syndrome and other postoperative complications significantly reduced, especially in the lungs, chest, left diaphragm less affected, as soon as possible to facilitate the recovery of patients . Conclusions Advanced schistosomiasis caused by liver disease and hypersplenism to superselective catheterization of the middle and lower extremity artery embolization embolization after treatment is ideal, the incidence of complications than the splenic artery trunk embolization was significantly reduced, the degree of discomfort was mild, patients Fast recovery, hospitalization time is short.