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Objective To compare and analyze the efficacy of PVA particles and Embosphere microspheres for partial splenic embolization (PSE)in the treatment of hypersplenism secondary to liver cirrhosis.Methods Sixty patients underwent PSE for treatment of hypersplenism secondary to liver cirrhosis were analyzed retrospectively.According to different PSE embolization materials,they were divided into two groups:30 patients with PVA particles embolization (group A),and other 30 patients with Embosphere microspheres embolization (group B).The changes of white blood cells (WBC),platelets (PLT),spleen thickness,portal vein diameter and postoperative pain and fever were compared on the 3rd day,the 1st week,the 3rd week,the 1st month,the 3rd month,and the 6th month after PSE and compared between the two groups.Results The WBC and PLT of the 2 groups after PSE were significantly higher than those before PSE (all P＜0.05 ).The spleen shrank after 2 months,and there was no significant difference in spleen thickness and portal vein diameter between the two groups at the same time (all P＞0.05).The postoperative pain in group A was significantly less than that in group B (P＜0.05).Conclusion Both PVA particles and Embosphere microspheres have good curative effect in the treatment of hypersplenism secondary to liver cirrhosis. The price of PVA particles is lower than that of Embosphere microspheres,and the postoperative pain degree is lighter than that of Embosphere microsphere,which suggests PVA particles with more advantages in clinical application.
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Objective To compare the efficacy of partial splenic embolization (PSE)with 150－350 μm and 350－560 μm polyvinyl alcohol (PVA).Methods A total of 24 patients were analyzed retrospectively in this study.Among them,9 patients underwent PSE with PVA of 1 50－350 μm (group A)and 1 5 patients with PVA of 350－560 μm (group B).Hematological parameters including white blood cell and platelet counts before and 1 week after surgery were compared between the two groups,as well as postoperative complications. Results The white blood cell and platelet counts were both significantly increased after 1 week of surgery compared with that before surgery (both P＜0.05).Furthermore,group A had obvious advantage over group B in increasing platelets (P＝0.05).The incidences of postoperative complications were 100% (9/9)in group A and 87% (13/15)in group B,respectively,but the incidence and severity of complications between two groups were comparable.Conclusion PSE with PVA of 1 50－3 50 μm has advantage in postoperative platelet improvement over PVA of 350－560 μm.
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BACKGROUND: Performing transarterial chemoembolization (TACE) is difficult with the occurrence of thrombocytopenia in cirrhotic patients with hepatocellular carcinoma (HCC). We aimed to evaluate the long-term efficacy and safety of partial splenic embolization (PSE) combined with TACE in patients with HCC with severe thrombocytopenia related to splenomegaly. METHODS: We conducted a case–control study consisting of 18 HCC patients with severe thrombocytopenia (< 50 × 109/L) who underwent PSE concurrently with TACE (PSE group) and 72 controls who underwent TACE alone (non-PSE group). RESULTS: Mean platelet counts at 1 month and 1, 3, and 5 years after concurrent PSE and TACE significantly increased compared with baseline (all P < 0.05), whereas the platelet count did not significantly increase after TACE alone. In addition, the platelet count at several time points after treatment in the PSE group was significantly higher than that in the non-PSE group, although the baseline platelet count in the PSE group was significantly lower than that in the non-PSE group. The platelet increase after PSE significantly reduced the need for platelet transfusions (P = 0.040) and enabled the subsequent TACE procedures in time (P = 0.046). The leukocyte counts and hemoglobin concentrations after concurrent PSE and TACE were also significantly increased, without deterioration of Child-Turcotte-Pugh score and unexpected side effects. CONCLUSION: PSE combined with TACE is effective in inducing and maintaining long-term thrombocytopenia improvement which reduces the need for the platelet transfusion and helps to perform initial and serial TACE, and is well-tolerated in patients with HCC and thrombocytopenia. PSE may be a promising treatment option for HCC patients with severe thrombocytopenia associated with splenomegaly who will undergo TACE.
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Humains , Plaquettes , Carcinome hépatocellulaire , Numération des leucocytes , Numération des plaquettes , Transfusion de plaquettes , Splénomégalie , ThrombopénieRÉSUMÉ
Hypersplenism is a common clinical manifestation of portal hypertension in hepatic cirrhosis.Clinical treatment of hypersplenism includes splenectomy,partial splenic embolization and liver transplantation.Splenectomy and partial splenic embolization are effective for hypersplenism,but the main complications are portal / splenic vein thrombosis (PSVT) and infection.Liver transplantation is an ideal method for the treatment of hypersplenism caused by cirrhosis,but patients with liver transplantation may still have persistent hypersplenism.Simultaneous splenectomy or partial splenic embolization which is performed with liver transplantation is a therapy of persistent hypersplenism.It can improve the function of graft but also increase the risk of infection.
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Objective To investigate the changes of splenic and portal venous pressure after partial splenic embolization (PSE),and to discuss its influence factors.Methods PSE was carried out in 14 patients with portal hypertension complicated by hypersplenism.Before and after PSE,the splenic and portal vein pressure was determined by direct manometry method.The post-operative venous pressure was compared with pre-operative one.Contrast-enhanced CT scan was performed 1-2 months after the treatment.Results After PSE,the splenic venous pressure was decreased obviously,a reduction of more than 2 cmH2O in portal venous pressure was observed in 7 patients.Post-operative reexamination with contrast-enhanced CT scan showed that varying degrees of improvement of esophageal and gastric varices could be observed in most patients.Conclusion PSE can effectively decrease the splenic venous pressure,and there are a lot of factors that may influence the short-term reduction in portal vein pressure.
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Objective To evaluate the effectiveness and safety of partial splenic embolization using polyvinyl alcohol versus gelfoam to treat hypersplenism in cirrhotic patients.Methods A literature search was performed in databases which included PubMed,Embase,Cochrane library,Sinomed,CNKI,Wangfang data and VIP for trials on partial splenic embolism using PVA or gelfoam to treat hypersplenism in cirrhotic patients.The study was censored in May 2016.After data extraction and assessment of quality,a meta-analysis was performed using the RevMan 5.3 software.Results Five studies which involved 197 patients were selected in this study.Included into the PVA group were 92 patients and the gelfoam group 105 patients.On Meta-analysis,the PVA group had a higher value of WBC a month after PSE (WMD =0.4,95％ CI:0.05 ～ 0.75,P ＜ 0.05),higher values of WBC (WMD =0.39,95％ CI:0.06 ～ 0.71,P ＜0.05) and PLT (WMD =8.08,95％ CI:1.65 ～ 14.51,P ＜ 0.05) on month 6 post-embolization.The degree of post-embolization pain was more severe (RR =1.32,95％ CI:1.14 ～ 1.54,P ＜ 0.05) and the length of painful time was longer (RR =2.01,95％ CI:1.36 ～ 2.66,P ＜0.05) in the PVA group.There were no significant differences in the values of PLT,fever and complications (all P ＞ 0.05).Conclusions PSE using PVA achieved better short-term and long-term results in hematological indicators than gelfoam.However,the degree and extent of duration of pain were significantly longer.
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Objective To discover the effect of partial splenic embolization on the immune function of cirrhotic patients with hypersplenism. Methods Patients involved in the study were enrolled and divided into three groups, including control group, experimental group, and complication group. Numbers of CD3
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OBJECTIVE@#To discover the effect of partial splenic embolization on the immune function of cirrhotic patients with hypersplenism.@*METHODS@#Patients involved in the study were enrolled and divided into three groups, including control group, experimental group, and complication group. Numbers of CD3(+), CD4(+) and CD8(+) T cells and CD4(+)CD25(+)CDl27(low/-) Treg cells in the peripheral blood of patients before surgery, 1 month, 6 months, 1 year, and 2 years after surgery were analyzed by fluorescence active cell sorting (FACS). Contents of immunoglobulins (IgA, IgG and IgM) were analyzed by auto immunoassay analyzer.@*RESULTS@#In the peripheral blood of patients from experimental group, numbers of CD3(+), CD4(+) and CD8(+) T cells initially declined, but afterwards increased to normal level; in the peripheral blood of patients from complication group, CD3(+) and CD8(+) T cells showed the same trend, but the number of CD4(+) T cells was below normal level at all detection times. Furthermore, CD3(+), CD4(+) and CD8(+) T cells in the peripheral blood of patients from complication group were initially less than those in experimental group, and afterwards were comparable between two groups. In patients from both experimental group and complication group, the number of CD4(+) CD25(+) CDl27(low/-)Treg cells increased 1 month and 6 months after surgery, and gradually restored to normal level. CD4(+)CD25(+)CDl27(low/-) Treg cell counts in patients from complication group were initially more than those in patients from experimental group 1 month and 6 months after surgery, but then they were comparable. Furthermore, contents of immunoglobulins (IgA, IgG and IgM) were comparable in three groups at all detection times.@*CONCLUSION@#Partial splenic embolization influenced the immune function of cirrhotic patients with hypersplenism in the short term but the immune function could afterwards gradually restore to normal. Our results implicated that measures that prevent infection and improve immune function were necessary in early stage after undergoing PSE in order to reduce complications.
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Objective To investigate the clinical effects of two different partial splenic embolization (PSE) methods in treating portal hypertension due to cirrhosis, and to statistically analyze the difference between the two PSE methods. Methods Sixty-two patients with cirrhotic portal hypertension complicated by hypersplenism were divided into group A (peripheral embolization group) and Group B (lower- pole embolization group). Partial splenic embolization with sponge was carried out in all patients of both groups. Before and after PSE color Doppler ultrasoundgraphy was performed to determine the inner diameter of the portal vein and splenic vein, the velocity and rate of flow, the length and thickness of spleen, etc. The results were compared between the two groups. Results The splenic embolization area within 60% - 80%was obtained in 42 patients, and the embolization area>80%was seen in 20 patients. After PSE, decreased flow velocity as well as flow rate was detected in all patients, and both the length and thickness of the spleen were also significantly reduced when compared with the data determined before PSE. The differences between the two groups were statistically significantly (P < 0.05). Conclusion Partial splenic embolization can effectively relieve the portal hypertension caused by cirrhosis, and selective peripheral arterial embolization is superior to splenic lower-pole embolization in decreasing the portal pressure.
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Patients with primary liver cancer are always associated with hypersplenism .The traditional treatment of hypersplenism is splenectomy .With the development of interventional imaging ,partial splenic emboli-zation has been used extensively in clinical practice .Hepatocellular carcinoma with hypersplenism patients by par-tial splenic embolization can obviously improve the blood , reduce the complications of portal hypertension .PSE combined with other treatment can prolong the survival of patients with hepatocellular carcinoma .In this paper ,the clinical application of PSE is reviewed .
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Nowadays partial splenic embolization (PSE) is an important therapeutic means to treat secondary hypersplenism caused by portal hypertension. By reducing the splenic blood flow and increasing hepatic blood supply, the peripheral blood picture and the liver function indexes as well as the portal hypertension can be effectively improved. This article aims mainly to make a comprehensive review on the therapeutic effect and mechanism of PSE, its clinical efficacy, as well as the factors affecting the clinical results, and to discuss the postoperative complications, the advantages and disadvantages of different embolic materials.
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Objective To retrospectively analyze the efficacy and safety of splenic embolization in the treatment of hypersplenism.Methods Thirty-six cases of hepatocellular carcinoma patients with cirrhosis,splenomegaly and hypersplenism underwent hepatocellular carcinoma embolization as well as with spleen embolization.White blood cells (WBC) and platelets were tested and postoperative clinical reactions were observed at 3,7,30 days and 3-6 months after the operation.Results The number of WBC and platelet were both significantly increased after the operation,the difference was significantly statistical [WBC:3 d:( 9.4 ±2.1 ) × 109/L,7 d:(9.3 ± 2.3 ) × 109/L,30 d:( 8.6 ± 2.1 ) × 109/L,3 months:( 6.4 ± 1.6 ) × 109/L vs (2.6 ± 1.4) × 109/L,P＜0.01;platelet:3 d:(94 ±23) × 109/L,7 d:(140 ±32) × 109/L,30 d:(136 ±38) ×109/L,3 months:( 119 ±26) × 109/L vs (32 ± 18) × 109/L,P＜0.01].All patients got fever,loss of appetite,nausea and pain in the spleen,of which 6 patients needed clinical treatment to control symptoms and left pleural effusion occurred in 3 patients,but without cases with serious complications.Conclusion The functional splenic artery blood flow embolization is a safe and effective treatment for liver cirrhosis caused by hypersplenism.
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Objective To discuss the effects and the complications of partial splenic artery embolization with gelatin sponge or with lipiodol for hypersplenism,to provide scientific information helpful for the selection of embolization materials in clinical practice.Methods Partial splenic artery embolization with gelatin sponge was performed in forty patients with hypersplenism due to cirrhosis(gelatin sponge group)and partial splenic artery embolization with lipiodol was carried out in another thirty-nine patients(lipiodol group).The clinical data were retrospectively analyzed.The laboratory studies,complications and recurrence were observed and compared between two groups.Results No significant difference in the reduction of splenic size,in the hemoglobin levels and in the thrombocyte and leucocyte counts existed between two groups(P＞0.05).However,the platelet count in lipiodol group was obviously decreased three months after the treatment.The occurrence of complications in gelatin sponge group was much higher than that in lipiodol group(P＜0.05).The toxic reaction of the liver and gastrointestinal tract in lipiodol group was significantly slighter than that in gelatin sponge group.Conclusion Partial splenic artery embolization with lipiodol should be employed for the treatment of hypersplenism when the patient is elder and the disease is accompanied by poor liver function,massive ascites,severe dysfunction of blood coagulation and serious portal hypertension.
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Objective To evaluate the efficacy of the combination of percutaneous transhepatic embolization of gastroesophageal varices (PEGV) and partial splenic embolization(PSE) for the treatment of variceal bleeding. Methods Fifty patients with cirrhosis who fit in with the requirements of the study were randomly divided into dual-interventional group and surgical group. The patients in dual-interventional group were treated with PEGV together with PSE, and the patients in surgery group were treated with Hassab's operation. After the procedure all the patients in two groups were followed up periodically. The endoscopy, B ultrasonography, liver function tests and hematologic examinations were performed 24 months after the therapy, and the results were statistically analyzed. Results Fifty patients were enrolled in this study. The procedures of embolization and surgery were successful in all patients. In dual-interventional group, the whit eblood cell and platelet counts were (2.33±0.65) 10~9/L and (3.63±1.05) ×10~9/L respectively before the treatment and were (7.98±3.0) ×10~9/L and (163±91)× 10~9/L respectively 24 months after the treatment (P<0.05). The diameter of theportal vein was (1.47±0.25) cm before the treatment and was(1.31±0.23) cm 24 months after the treatment (P<0.05). The severity of esophageal varices decreased from grade Ⅲ to lower grade Ⅱ in 11 patients, and from grade Ⅱ to lower grade Ⅰ in 6 patients 24 months after procedure. Portal thrombosis occurred in 1 case. The recurrent bleeding rate was 16% (4/25) 24 months after treatment. Three patients died of the recurrent bleeding, one patient died of hepatic failure. In surgical group, the white blood cell and platelet counts were (2.2±0.60) ×10~9/L and (41±12.5) ×109/L before treatment, and were (9.3±2.56)×10~9/L and (321±12.5)×10~9/L 24 months after treatment (P<0.05). The diameter of the portal vein was (1.43±0.22) cm before the treatment and was (1.28±0.18) cm after the treatment (P<0.05). The severity of esophageal varices decreased from grade Ⅲ to lower grade Ⅱ in 13 patients, and from grade Ⅱ to lower grade Ⅰ in 7 patients. Four patients developed portal thrombosis after the procedure. The recurrent bleeding rate was 20%(5/25), 2 patients died of hepatic failure after the surgery, 2 died of recurrent bleeding. Conclusion In treating patients with cirrhosis, the combination of PGEV and PSE, regarded as dual-interventional therapy, is very effective, especially in controlling recurrent bleeding and in improving white blood cell and platelet counts.
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Objective To analyze the effects and the complications of partial splenic artery embolization(PSE)and splenectomy offering a feasible way to choose different therapeutic methods for hypersplenism. Methods Forty-six patients treated with PSE and thirty-three undergone splenectomy were compared for their effectivenesses and complications in treating hypersplenism. Results Thrombocyte and leucocyte counts increased markedly after the two kinds of treatment(P 0.05). The complication rate of the PSE was far more than that of the splenectomy(P
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Posttranplantations lymphoproliferative disease (PTLD) is a common and life-threatening complication for soid organ transplantation associated with the use of chronic immunosuppression and Epstein-Barr virus. There is no standardized treatment algorithm, but numerous management strategies are vaiable. Partial splenic embolization (PSE) had been demonstrated to be an effetive alternatie to splenectomy for patients hypersplenism and portal hypertension. PSE has the advantages of non-invasive intervention and resolution of the complications of hypersplenism. We report the effect of the PSE in a 6-year old male liver transplantation recepient with PTLD who has undergone persistent hypersplenism post-transplant. We reduced immunosuppression agent, started antiviral agent. We started with interferon and IV globulin one month after admission. Hepatosplenomegaly and cervical lymphadenopathy were improved. But fever was not subside. We selectively embolized the lower pole of the spleen to achieve a 50~60% reduction in flow as determined by angiography. After embolization, fever subside and peripheral blood findings were improved. Follow up abdominal CT revealed reduced volume of spleen due to ischemic change and there was no multiple enlarged mesenteric lymphnode compared to preembolization state. We thick that PSE is a safe an effetive treatment modality of PTLD with persistent hypersplenism in patients twho failed to medical treatment.
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Enfant , Humains , Mâle , Angiographie , Fièvre , Études de suivi , Herpèsvirus humain de type 4 , Hypersplénisme , Hypertension portale , Immunosuppression thérapeutique , Interférons , Transplantation hépatique , Maladies lymphatiques , Transplantation d'organe , Rate , Splénectomie , Tomodensitométrie , TransplantsRÉSUMÉ
Objective To study the continuous drainage treatment by percutaneous puncture of Splenic Abscess (SA), which is due to double-embolization for treatment of liver cancer with hypersplenism. Methods 158 patients with liver cancer with hypersplenism were adopted as the subjects, of which, 7 ones were complicated with SA. Results The symptoms of the 7 ones were all alleviated, such as fever, abdominal pain, left interior pain. Conclusion Continuous drainage treatment by percutaneous puncture, combined with flushing abscess cavity by antibiotics solution, is very effective for SA due to double-embolization.
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BACKGROUND: Initial treatment of chronic idiopathic thrombocytopenic purpura (ITP) is generally done with corticosteroid. In case of refractory to corticosteroid or dependency, splenectomy seems to be the most effective and definitive treatment. Partial splenic embolization is an easier procedure with minimal morbidity. We evaluated the efficacy and complications of partial splenic embolization as treatment of chronic ITP refractory to corticosteroid or corticosteroid dependency. METHODS: Eight patients with chronic ITP and two systemic lupus erythematosus (SLE) patients with immunothrombocytopenia underwent partial splenic embolization. Embolization of 70~80% of the splenic volume was performed with endocoils or gelform particles without anesthesia by selective arterial catheterization and followed up for 4~50 months. The therapeutic effect of partial splenic embolzation was defined on the basis of the platelet count at the last follow-up after partial splenic embolzation : complete response, >100,000/nL,partial response, 100,000~50,000/nL and no response, <50,000/nL without medication. RESULTS: Partial splenic embolization brought a complete response in six of ten patients, a partial response in three, and no response in one. With a follow-up of 4~50 months, these responses were maintained in all except three patients. One patient was treated by splenectomy and one by partial splenic embolization again. Tolerance was good in all patients. Abdominal pain and fever was observed in 8 and 4 patients, respectively. One patient had a left pleural effusion with spontaneous resolution. No serious infection occurred. All patients were discharged within 6 days after partial splenic embolization. CONCLUSION: We conclude that partial splenic embolization may be useful and safe procedure and a good alternative to splenectomy in chronic ITP refractory to medical treatment.
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Humains , Douleur abdominale , Anesthésie , Cathétérisme , Cathéters , Fièvre , Études de suivi , Lupus érythémateux disséminé , Numération des plaquettes , Épanchement pleural , Purpura thrombopénique idiopathique , SplénectomieRÉSUMÉ
Objective To evaluate the clinical efficiency of partial splenic embolization on portal hypertension patients of hepatocellulocarcinoma(HCC).Methods 110 patients of hepatocellulocarcinoma with portohypertension were treated with 1-3 times of TACE, and partial splenic embolization, with PVA of 355～500 ?m injecting into the arteries of inferior splenic pole. In order to control the area of splenic embolization, multi-embolizations were done according to the various conditions. Results 172 times of embolization were performed in 110 patients involving 134 times of fever lasting for 3-30 days and 126 times of bellyache with 27 times appealing for morphine. Treatable hydrothorax appeared in six, and no serious complications occurred. The area of embolization covered 30%～60%. WBC and BPC counts were increased after the 24 hour (P