脾动脉栓塞术对肝硬化脾功能亢进患者凝血功能的影响
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摘要
目的探讨脾动脉栓塞术对肝硬化脾功能亢进患者凝血功能的影响。方法选取2016年1月—2018年7月新乡医学院第一附属医院收治的49例肝硬化脾功能亢进患者作为脾栓塞组。回顾性分析患者脾动脉栓塞术治疗前及治疗后3周内凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、国际标准化比值(INR)、凝血酶时间(TT)及纤维蛋白原(FIB)的变化。另选取本院同期收治的采用常规保守治疗的40例肝硬化脾功能亢进患者作为对照组。结果脾栓塞组APTT治疗前后分别为(46.063±11.477)和(40.243±8.973)s,FBG治疗前后分别为(155.346±39.930)和(267.289±101.644)mg/ml,TT前后分别为(22.860±2.749)和(20.600±2.437)s。脾栓塞组APTT、FIB及TT指标治疗前后比较,差异有统计学意义(P <0.05);而PT、INR治疗前后比较,差异无统计学意义(P>0.05)。结论脾动脉栓塞术能够降低门静脉系统压力、减轻脾亢进功能症状,还可以改善肝硬化脾亢患者的凝血功能。
Objective To investigate the effect of splenic arterial embolization on coagulation function in patients with liver cirrhosis and hypersplenism. Methods In the experimental group, 49 patients with hypersplenism due to cirrhosis admitted to the First Affiliated Hospital of Xinxiang Medical College from January 2016 to July2018 were selected. The changes of PT, APTT, INR, TT and FBG before and within 3 weeks after splenic artery embolization were analyzed retrospectively. In the control group, 40 patients with cirrhosis and hypersplenism were treated conservatively. Results The levels of APTT were(46.063±11.477) s before treatment and(40.243±8.973)s after treatment; The levels of FBG were(155.346±39.930) mg/ml before treatment and(267.289±101.644) mg/ml after treatment; The levels of TT were(22.860±2.749) s before the treatment and(20.600±2.437) s after treatment.The changes of APTT, FBG and TT were statistically significant before and after operation in the experimental group(P < 0.05), but there was no statistical difference in PT and INR(P > 0.05). Conclusions Splenic arterial embolization can reduce the pressure of portal vein system, alleviate symptoms of hypersplenism, and improves the coagulation function of cirrhotic patients with splenic hypersplenism.
Objective To investigate the effect of splenic arterial embolization on coagulation function in patients with liver cirrhosis and hypersplenism. Methods In the experimental group, 49 patients with hypersplenism due to cirrhosis admitted to the First Affiliated Hospital of Xinxiang Medical College from January 2016 to July2018 were selected. The changes of PT, APTT, INR, TT and FBG before and within 3 weeks after splenic artery embolization were analyzed retrospectively. In the control group, 40 patients with cirrhosis and hypersplenism were treated conservatively. Results The levels of APTT were(46.063±11.477) s before treatment and(40.243±8.973)s after treatment; The levels of FBG were(155.346±39.930) mg/ml before treatment and(267.289±101.644) mg/ml after treatment; The levels of TT were(22.860±2.749) s before the treatment and(20.600±2.437) s after treatment.The changes of APTT, FBG and TT were statistically significant before and after operation in the experimental group(P < 0.05), but there was no statistical difference in PT and INR(P > 0.05). Conclusions Splenic arterial embolization can reduce the pressure of portal vein system, alleviate symptoms of hypersplenism, and improves the coagulation function of cirrhotic patients with splenic hypersplenism.
引文
[1]徐小元,丁惠国,贾继东,等.肝硬化门静脉高压食管胃静脉曲张出血防治指南(2015)[J].中华胃肠内镜电子杂志,2015,2(4):1-21.
[2]丁惠国,徐小元,令狐恩强,等.《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》解读[J].临床肝胆病杂志,2016,32(2):220-222.
[3]MADDISON F E.Embolic therapy of hypersplenism[J].Invest Radiol,1973,8(4):280-281.
[4]WANG Y B,ZHANG J Y,ZHANG F,et al.Partial splenic artery embolization to treat hypersplenism secondary to hepatic cirrhosis:a meta-analysis[J].Am Surg,2017,83(3):274-283.
[5]何海冠,沈艺南,庞书杰,等.脾切除术与部分脾动脉栓塞术治疗肝硬化脾功能亢进近期疗效比较的Meta分析[J].临床肝胆病杂志,2016,32(2):301-306.
[6]WU B G,CHOU A S B,HO G J,et al.Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism[J].Formosan Journal of Surgery,2017,50(3):101-106.
[7]马立辉,周健,史丽民,等.脾动脉栓塞术对肝癌伴脾亢患者免疫功能的影响[J].世界华人消化杂志,2010,18(7):669-675.
[8]梁晓华,张峰,诸葛宇征.经颈静脉肝内门体分流术联合脾动脉栓塞对肝硬化患者肝脏血流动力学和肝功能的影响[J].临床肝胆病杂志,2016,32(11):2112-2117.
[9]PANT A,KOPEC A K,LUYENDYK J P.Role of the blood coagulation cascade in hepatic fibrosis[J].Am J Physiol Gastrointest Liver Physiol,2018,315(2):171-176.
[10]宁会彬,尚佳.肝硬化患者凝血功能障碍的探讨[J].临床肝胆病杂志,2016,32(6):1083-1085.
[11]PANG X,LI T,WANG C.Splenic artery embolization with detachable balloons for hypersplenism.Journal of International Medical Research[J].2018,46(10):4111-4119.
[12]张克勤,贾克东,李娅娅,等.部分脾动脉栓塞联合内镜下硬化治疗重度食管静脉曲张的疗效观察[J].介入放射学杂志,2013,22(6):504-507.
[13]HADDUCK T A,MCWILLIAMS J P.Partial splenic artery embolization in cirrhotic patients[J].World Journal of Radiology,2014,6(5):160-168.
[2]丁惠国,徐小元,令狐恩强,等.《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》解读[J].临床肝胆病杂志,2016,32(2):220-222.
[3]MADDISON F E.Embolic therapy of hypersplenism[J].Invest Radiol,1973,8(4):280-281.
[4]WANG Y B,ZHANG J Y,ZHANG F,et al.Partial splenic artery embolization to treat hypersplenism secondary to hepatic cirrhosis:a meta-analysis[J].Am Surg,2017,83(3):274-283.
[5]何海冠,沈艺南,庞书杰,等.脾切除术与部分脾动脉栓塞术治疗肝硬化脾功能亢进近期疗效比较的Meta分析[J].临床肝胆病杂志,2016,32(2):301-306.
[6]WU B G,CHOU A S B,HO G J,et al.Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism[J].Formosan Journal of Surgery,2017,50(3):101-106.
[7]马立辉,周健,史丽民,等.脾动脉栓塞术对肝癌伴脾亢患者免疫功能的影响[J].世界华人消化杂志,2010,18(7):669-675.
[8]梁晓华,张峰,诸葛宇征.经颈静脉肝内门体分流术联合脾动脉栓塞对肝硬化患者肝脏血流动力学和肝功能的影响[J].临床肝胆病杂志,2016,32(11):2112-2117.
[9]PANT A,KOPEC A K,LUYENDYK J P.Role of the blood coagulation cascade in hepatic fibrosis[J].Am J Physiol Gastrointest Liver Physiol,2018,315(2):171-176.
[10]宁会彬,尚佳.肝硬化患者凝血功能障碍的探讨[J].临床肝胆病杂志,2016,32(6):1083-1085.
[11]PANG X,LI T,WANG C.Splenic artery embolization with detachable balloons for hypersplenism.Journal of International Medical Research[J].2018,46(10):4111-4119.
[12]张克勤,贾克东,李娅娅,等.部分脾动脉栓塞联合内镜下硬化治疗重度食管静脉曲张的疗效观察[J].介入放射学杂志,2013,22(6):504-507.
[13]HADDUCK T A,MCWILLIAMS J P.Partial splenic artery embolization in cirrhotic patients[J].World Journal of Radiology,2014,6(5):160-168.