Partial splenic embolization for the treatment of hypersplenism of cirrhosis

Abstract

Aim To study the clinical effects of partial splenic embolization (PSE) in patients with hypersplenism of cirrhosis, observe the prevention and treatment of side effects of PSE. Methods One hundred and twenty six patients with hypersplenism and portal hypertension complicated with hepatic cirrhosis received Seldinger′s technology partial splenic embolization using sponge. Blood routine analysis, splenic length and thickness assay, portal and splenic vein internal diameter assay were tested regularly pre-PSE and post-PSE, and complications were observed and treated. Results Embolismic area was less than 30% in 8 patients, 30%～60% in 66 patients, 60%～80% in 42 patients and more than 80% in 10 patients. Except 8 patients of less than 30%, other patients blood cells were raised obviously. One week after PSE, white blood cell (WBC,×109·L-1) and platlet (PLT,×109·L-1) were 7.48±3.52, 86.35±38.47 respectively (P0.01, vs 2.17±0.46, 35.63±8.42,pre-PSE), hemoglobin(HGB,×g·L-1) was 104.36±16.72 (P0.05, vs 98.58±17.46,pre-PSE). One month after PSE, blood WBC, PLT and HGB were 4.48±0.56,121.49±28.20 and 124.46±10.84 respectively (P0.01,vs 7.48±3.52, 86.35±38.47 and 98.58±17.46,pre-PSE). Post-PSE from three to six months, splenic length and thickness(cm) in 118 patients with embolismic area more than 30% were 14.32±3.26, 5.68±1.12 respectively (P0.01, vs 17.42±2.65, 7.54±2.14,pre-PSE). Complications were found in 41 patients (41/126), 4 of them were from 66 patients with 30%～60% embolization area, the rate was 6.06%; 27 of them were from 42 patients with 60%～80%, the rate was 64.29%; another 10 patients were from 10 patients with more than 80%, the rate was 100%. Those complications included hydrothorax, ascites, pertinacious, left lower pneumonia, splenic and ubphrenic abscess. The incidence and severity of complications after PSE were related directly to the embolization extent (P0.01). Conclusion PSE was effective in improving hypersplenism and reducing portal hypertension. Proper extent of embolization may decrease the incidence rat of complications, intensive anti-infection .