目的:本研究的目的是探讨肝硬化脾肿大患者部分脾栓塞术后联合应用低分子肝素+地塞米松的疗效和安全性。
方法:本研究纳入了2016年1月至2019年12月在协和医院接受PSE治疗的116例肝硬化合并巨大脾肿大患者,且符合标准。分为PSE+Hep+Dex组(N=54)和PSE组(N=62)。我们进行了回顾性研究,以分析两组患者的疗效和安全性。
结果:PSE+Hep+DEX组的脾栓塞体积为622.34±157.06cm3,PSE组为587.62±175.33cm3(P=0.306)。两组脾栓塞率比较差异无统计学意义(P=0.573)。两组白细胞在PSE后1周达到高峰,PLT在PSE后1个月达到高峰;后来逐渐下降。但在12个月随访期间明显高于术前水平。腹痛的发生率(46.3%vs66.1%,P=0.039),发烧(38.9%和75.8%,P<0.001),PVT(1.9%对12.9%,P=0.026),顽固性腹水(5.6%对19.4%,P=0.027)在PSE+Hep+DEX组中低于PSE组。术后第2~8天,PSE组腹痛VAS评分高于PSE+Hep+DEX组(P<0.05)。PSE组1例(1.6%)发生脾脓肿,PSE+Hep+DEX组无脾脓肿(0.0%)(P=0.349)。
结论:PSE后联合使用地塞米松和低分子肝素是一种安全有效的治疗策略,可以显着降低PSE后并发症的发生率(例如栓塞后综合征,PVT,难治性腹水)。
OBJECTIVE: The aim of this study was to investigate the efficacy and safety of the combination of low-molecular-weight heparin + dexamethasone after partial splenic embolization in cirrhotic patients with massive splenomegaly.
METHODS: This study included 116 patients with liver cirrhosis complicated with massive splenomegaly who underwent PSE in Union Hospital from January 2016 to December 2019, and they met the criteria. They were divided into two groups: PSE + Hep + Dex group (N = 54) and PSE group (N = 62). We conducted a retrospective study to analyze the efficacy and safety of the two groups of patients.
RESULTS: The volume of splenic embolization was 622.34 ± 157.06 cm3 in the PSE + Hep + DEX group and 587.62 ± 175.33 cm3 in the PSE group (P = 0.306). There was no statistically difference in the embolization rate of the spleen between the two groups (P = 0.573). WBC peaked 1 week after PSE and PLT peaked 1 month after PSE in both groups; it gradually decreased later, but was significantly higher than the preoperative level during the 12-month follow-up period. The incidences of abdominal pain (46.3% vs 66.1%, P = 0.039), fever (38.9% vs 75.8%, P < 0.001), PVT (1.9% vs 12.9%, P = 0.026), refractory ascites (5.6% vs 19.4%, P = 0.027) were lower in the PSE + Hep + DEX group than in the PSE group. The VAS score of abdominal pain in PSE group was higher than that in PSE + Hep + DEX group on postoperative days 2-8 (P < 0.05). Splenic abscess occurred in 1(1.6%) patient in the PSE group and none (0.0%) in the PSE + Hep + DEX group (P = 0.349).
CONCLUSIONS: The combined use of dexamethasone and low-molecular-weight heparin after PSE is a safe and effective treatment strategy that can significantly reduce the incidence of complications after PSE (such as post-embolization syndrome, PVT, refractory ascites).