本文選題：門脈高壓　切入點：脾功能亢進　出處：《青島大學(xué)》2016年碩士論文

【摘要】：目的:探討脾動脈主干栓塞用于治療門脈高壓并脾功能亢進的臨床效果,并對比傳統(tǒng)的部分性脾栓塞,總結(jié)其優(yōu)勢與不足。方法:自2014年1月起至2015年3月,將于我科就診手術(shù)的26例門脈高并脾功能亢進壓患者分為A、B兩組,A組18例患者應(yīng)用不銹鋼彈簧圈及可脫離球囊行脾動脈主干栓塞,B組8例患者應(yīng)用PVA顆粒行部分性脾栓塞。術(shù)后均隨訪半年以上,將A組患者術(shù)前術(shù)后臨床表現(xiàn)、外周血三系變化、脾臟最大徑、門脈內(nèi)徑進行對比,觀察脾動脈主干栓塞對門脈高壓并脾亢的治療效果;將B組患者術(shù)前術(shù)后外周血三系變化、門脈內(nèi)徑變化進行對比,觀察部分性脾栓塞對于門脈高壓并脾功能亢進的治療效果;將A、B兩組患者術(shù)后不良反應(yīng)及并發(fā)癥、外周血三系變化、門脈內(nèi)徑變化進行對比,比較兩種手術(shù)方式治療門脈高壓并脾亢的效果差異。結(jié)果:A組:該組18例患者中,1例患者術(shù)中突發(fā)上消化道出血,搶救無效死亡,1例患者術(shù)后又轉(zhuǎn)外科行脾切除術(shù)+食管胃底靜脈結(jié)扎,2例患者造影證實為肝動脈-門脈畸形,行畸形血管栓塞治療后門脈高壓緩解。余14例患者行脾動脈主干栓塞術(shù),術(shù)后臨癥狀改善,8例患者出血術(shù)后即停止,6例仍有少量活動性出血,經(jīng)內(nèi)科進一步對癥處理后出血停止,隨訪期間均未再發(fā)大出血;14例患者食管胃底靜脈曲張緩解,外周血細胞三系升高,脾臟體積減小,差異均具有統(tǒng)計學(xué)差異(P≤0.05);術(shù)后門脈內(nèi)徑減小,術(shù)后1月門脈內(nèi)徑對比術(shù)前門脈內(nèi)徑減小,差異具有統(tǒng)計學(xué)差異(P≤0.05),但術(shù)后3月、6月門脈內(nèi)徑對比術(shù)前則無統(tǒng)計學(xué)差異。B組:8例患者均成功行部分性脾栓塞術(shù),栓塞面積約1/3,患者術(shù)前術(shù)后外周血三系不同程度升高,具有統(tǒng)計學(xué)差異(P≤0.05),但門脈內(nèi)徑變化無統(tǒng)計學(xué)差異(P≥0.05),證明其對門脈高壓的緩解效果欠佳。A、B兩組對比:A組術(shù)后外周血三系變化較B組無統(tǒng)計學(xué)差異;A組術(shù)后門脈內(nèi)徑減小而B組無變化;A組術(shù)后不良反應(yīng)及并發(fā)癥發(fā)生率小于B組,差異有統(tǒng)計學(xué)意義(P≤0.05)。結(jié)論:1:脾動脈主干栓塞用于治療門脈高壓并脾功能亢進的效果確切,術(shù)后不良反應(yīng)輕,可快速降低門脈壓力,緩解臨床癥狀,尤其適用于一般情況較差的患者。2:部分性脾栓塞可使外周血三系升高,但對降低門脈壓力的效果欠佳,與前人研究數(shù)據(jù)有差異,可能與本組病例數(shù)較少有關(guān)。3:脾動脈主干栓塞較傳統(tǒng)部分性脾栓塞具有一定優(yōu)勢,短期內(nèi)臨床效果明顯,但遠期效果,尤其是對于長期降低門脈壓力的效果尚需更加豐富的臨床資料進行論證。
[Abstract]:Objective: To investigate the clinical effect of splenic artery embolization for the treatment of portal hypertension and hypersplenism, partial splenic embolization and compared with the traditional, summarizes its advantages and disadvantages. Methods: from January 2014 to March 2015, in our hospital of surgery of 26 cases of portal vein and spleen function hyperfunction of high pressure patients were divided into A, B two groups, A group of 18 patients using stainless steel coil and detachable balloon for splenic artery embolization, 8 cases in B group by PVA granules for partial splenic embolization. All patients were followed up for more than half a year, the A group before and after surgery in patients with clinical manifestations and changes of three peripheral blood. The maximum diameter of the spleen, the diameter of the portal vein were compared, observation of splenic artery embolization on portal hypertension and hypersplenism treatment; three patients will change B group before and after peripheral blood changes, the diameter of the portal vein were compared to observe partial splenic embolization for portal hypertension and hypersplenism Treatment effect; A, B two groups of patients with postoperative adverse reaction and complications, three changes of peripheral blood, change the diameter of the portal vein were compared, the difference between the two types of surgical treatment of portal hypertension and hypersplenism. Results: A group: the group of 18 patients, 1 sudden hemorrhage of digestive tract in one patient, died, 1 patients after surgical splenectomy + esophageal variceal ligation, 2 cases of patients with hepatic artery angiography of portal vein malformations, for vascular malformation embolization in the treatment of portal hypertension in patients with remission. More than 14 cases of splenic artery embolization, postoperative clinical symptoms improved that is, 8 cases of patients with postoperative bleeding stopped in 6 cases, there is still a small amount of bleeding, the bleeding stopped after the symptomatic treatment, further follow-up, there was no recurrence of bleeding; 14 cases of patients with esophageal and gastric varices remission, the peripheral blood cells of three increased spleen volume decreased, the difference was With statistical difference (P = 0.05); patients with portal vein diameter reduced, postoperative 1 Comparison of preoperative portal vein diameter moongates diameter reduced, a statistically significant difference (P = 0.05), but after March, the 6 moongates diameter compared to preoperative veins there were no significant differences between.B group: 8 cases were successfully performed partial splenic embolization, embolization area of about 1/3, patients with preoperative and postoperative peripheral blood of three lines increased, with statistical difference (P < 0.05), but no significant difference in the diameter of the portal vein (P = 0.05), prove the portal hypertension relieving effect of.A, B between the two groups: A after three changes in peripheral blood than B group showed no significant difference in A group; portal vein diameter reduced while the B group had no change; group A postoperative adverse reaction and complication rate of less than B group, the difference was statistically significant (P = 0.05). Conclusion: 1: splenic artery embolization for the treatment of the door portal hypertension and hypersplenism effect Sure, postoperative adverse reactions, can quickly reduce portal pressure, alleviate the clinical symptoms, especially in patients with poor general condition of.2: partial splenic embolization can make the peripheral blood of three lines increased, but to reduce portal pressure effect is poor, is different from the previous research data, and could this group of cases the number is less about the trunk.3: splenic artery embolization with traditional partial splenic embolization has certain advantages, in the short term clinical effect is obvious, but the long-term effect, especially for the long term reduction of portal pressure effect still need more clinical data for the demonstration.

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R657.63

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