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 Wysłany: Śro 8:30, 30 Mar 2011 Temat postu: Partial splenic embolization for hypersplenism in |
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Partial splenic embolization for hypersplenism in 12 cases
6 years to 70 years, mean 52 years. 12 patients with the clinical diagnosis of liver cirrhosis with hyperthyroidism, 2 cases of Sino-Japanese Friendship Hospital, 2002 16 No. 5-6 JournalofChina-JapanFriendshipHospital,[link widoczny dla zalogowanych], 2002Dec, Vo1.16, No. 5-6353 primary liver cancer, the average liver disease> 10a. 12 patients with varying degrees of epistaxis, gum bleeding, skin bleeding bleeding tendency and other activities. Conventional anti-cirrhosis treatment is not given to stop the bleeding, the loser of blood platelets and other cell products rose, while digital subtraction angiography in the 1350mA upstream of partial splenic embolization. Seldinger technique using femoral artery catheterization, X-ray monitoring, the catheter was inserted to the artery, then to 6-8ml / s rate of injection of contrast agent for abdominal angiography to see blood vessels, spleen size and splenic vein and whether the thrombus. After imaging X-ray monitoring, the catheter into the deeper parts, re-injection of a small amount of contrast agent to confirm whether the catheter tip in the splenic artery. Gentamicin also soaked into the gelatin sponge particles 2mm × 2mm, splenic arterial blood flow to be slowed down, confirmed the splenic embolization of a 30% 20% ..., extubation, needle injection, compression bandaging, after 15min, sandbags oppression, limb braking 24h, observe the dorsalis pedis artery pulse situation. While patients with primary hepatic artery embolization. Results there were 12 cases of varying degrees of fever, left upper abdominal pain were gone within 1 week. 1 week epistaxis, gingival bleeding, active bleeding symptoms. Table 1 shows, 2 weeks after embolization check routine, higher than the preoperative mean platelet 30.17 × 10 '/ L, white blood cells increased by an average 1.17 × 10 / L; spleen spleen ultrasound showed the average thickness of the back compared with the preoperative reduction 0.87cm, compared before and after surgery were statistically significant (P <0.05). The group of 12 patients died due to liver cancer in 2 cases, 1 case due to 20d after gastrointestinal hemorrhage caused by consumption of hawthorn piece vessel devascularization splenectomy, and the remaining 9 cases reviewed after six months, ultrasound of spleen had no significant increase The mean preoperative platelet still about 1.5 million increase, the average increase in white blood cells 1.0 × 10 '/ L, consistent with national coverage of basic j. Table 1 Partial splenic embolization in patients before and after comparison of the indicators Note:} compared with before embolization, P <0.05. Discussion of our more common in patients with cirrhosis to hepatitis, immune insufficiency or acute hepatitis and chronic low until an important factor in liver cirrhosis, and liver cirrhosis and hypersplenism caused bleeding is the main reason, therefore, to eliminate patients with cirrhosis hypersplenism and splenic immune function are equally important to retain. In the past to improve the use of splenectomy in patients with hematological hypersplenism situation, but through the spleen physiology, pathology and further understanding of splenectomy is no longer considered irrelevant. Splenic white pulp and red pulp by a two-part, white pulp composed of dense lymphoid tissue structure, is the main distribution area of T lymphocytes. Sinusoid by the number of splenic red pulp, macrophages sinus wall endothelial cells. Spleen and splenic artery embolization can be blocked by the main or peripheral branches of the splenic blood supply reduced in real terms, reducing the splenic vein, portal vein pressure. While red pulp infarction in peripheral parts of the spleen, causing reduced phagocytic function, while the compact white pulp intact, well-preserved immune function. Eliminating hypersplenism, the spleen retained the immune function. Intraoperative embolization by angiography to observe the area. Embolic agent containing contrast agent flow rate slows, the shows have a 30% 20% embolization, there are interruptions such as the contrast medium, the occlusion area of 50% to 60%. As this group just to work during the first embolization treatment of small size, on the other embolic agents can be changed out in order to better calculate sponge embolization area. Partial splenic embolization and splenectomy compared to the one hand, reduce the immune function after splenectomy to reduce the infection caused the other hand, reduce the number of blood cells due to chronic low after splenectomy hypercoagulable state was caused due to an important dirty control the hazards of low perfusion, and little pain, bear the costs low. Such as the condition of patients often can be re-staged PSE j, to increase the embolic area, and further improve the outcome.
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