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目的探讨部分脾动脉栓塞术治疗艾滋病毒(HIV)阳性患者肝硬化继发脾功能亢进的临床效果。方法 6例HIV阳性肝硬化继发脾脏功能亢进患者,术前行B超、CT检查,常规行部分脾动脉栓塞术。分别检测患者术前、术后血细胞计数、肝功能以及门静脉血流动力学变化,监测术后并发症情况。结果术前血小板(PLT)、白细胞(WBC)和红细胞(RBC)分别为(58.3±15.0)×10~9/L、(2.24±0.58)×10~9/L和(2.97±0.78)×10~9/L,术后1周PLT、WBC明显升高(P<0.05),红细胞变化不明显。术后1周丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)稍有升高,但2周恢复正常,白蛋白(ALB)术后均升高。部分脾动脉栓塞术(PSE)后门静脉内径、血流速度及血流量均较前减低,但差异无统计学意义(P>0.05)。所有患者术后均无严重并发症发生。结论部分脾动脉栓塞术治疗HIV阳性肝硬化继发脾功能亢进可减轻患者血细胞减少,短期内肝功能恢复较好,未出现明显并发症。
Objective To investigate the clinical effects of partial splenic arterial embolization in the treatment of hypersplenism secondary to liver cirrhosis in HIV-positive patients. Methods Six patients with HIV positive cirrhosis secondary to hypersplenism were examined with B ultrasound and CT before operation. The preoperative and postoperative blood counts, liver function and portal hemodynamic changes were measured and the postoperative complications were monitored. Results The preoperative PLT, WBC and RBC were (58.3 ± 15.0) × 10 9 / L, (2.24 ± 0.58) × 10 9 / L and (2.97 ± 0.78) × 10 ~ 9 / L, PLT and WBC increased significantly at 1 week after operation (P <0.05), and the change of erythrocytes was not obvious. After 1 week, ALT and AST increased slightly, but returned to normal after 2 weeks, albumin (ALB) increased after operation. The diameter of portal vein, blood flow velocity and blood flow decreased after partial splenic arterial embolization (PSE), but the difference was not statistically significant (P> 0.05). All patients had no serious complications after surgery. Conclusions Some splenic arterial embolization in the treatment of secondary hypersplenism caused by HIV-positive cirrhosis can reduce the cytopenia in patients with short-term recovery of liver function is better, no significant complications.