| Objective:By comparing the clinical follow-up data of microsphere quantitative one-time Partial splenic embolization(PSE)and fractional partial splenic embolization in patients with severe hypersplenism at different time intervals,the optimal treatment mode of PSE was explored.To provide guidance for improving PSE curative effect and reducing postoperative complications.Methods:Clinical data of patients undergoing microscopically quantified PSE due to cirrhosis and severe hypersplenism in the First Affiliated Hospital of Kunming Medical University from January 2019 to December 2021 were collected,and 69 patients with complete follow-up data for 12 months were included.Patients were divided into three groups according to different PSE surgical methods: There were 30 cases in group A(one-time partial splenic artery embolization),24 cases in group B(1month interval partial splenic artery embolization)and 15 cases in group C(3 months interval partial splenic artery embolization).The observation time was calculated after the first embolization.Hematological and serum biochemical indexes(blood routine,liver function and coagulation function),indexes related to spleen embolization(preoperative spleen volume,postoperative residual spleen volume,infarcted spleen volume and splenic infarction rate)and postoperative complications of patients in the three groups were collected before surgery,1 week,1 month,3 months,6 months,and12 months after surgery.SPSS25.0 software was used for statistical analysis of the above indexes,and P < 0.05 was considered statistically significant.Results:1.Baseline dataA total of 69 cirrhotic patients with severe hypersplenism were included in this study,including 30 cases in group A(single splenic artery embolization),24 cases in group B(1 month interval partial splenic artery embolization),and 15 cases in group C(3 months interval partial splenic artery embolization).Baseline data of gender,age,preoperative liver function indexes(albumin,total bilirubin,aspartate aminotransferase,alanine aminotransferase),Chid-Pugh grading,peripheral blood image(white blood cell,red blood cell,platelet count)and preoperative spleen volume of patients in 3 groups were compared,and all P values were > 0.05,with no statistical significance.2.Changes of peripheral blood platelet count at different periods after PSE in three groupsCompared with the preoperative results,the PLT count of the three groups was significantly increased at each follow-up time point(P < 0.001),and the difference was statistically significant.One week and one month after surgery,PLT count in group A was significantly higher than that in group B and Group C(P=0.02,P=0.008;P=0.003,P=0.032),there was no significant difference in PLT count between group B and group C(P=0.512;P=0.614);Three months after surgery,PLT count in group B was higher than that in group A and C(P=0.005,P < 0.001),and PLT count in group A was higher than that in group C(P < 0.001).6 months and 1 year after surgery,PLT count in group B was significantly higher than that in groups A and C(P=0.001,P=0.049;P=0.001,P=0.008),there was no significant difference in PLT count between groups A and C(P=0.288;P=0.869).3.Comparison of peripheral white blood cell count at different periods after PSE in the three groups:Compared with the preoperative results,the WBC count of the three groups was significantly increased at each follow-up time point(P < 0.001),the difference was statistically significant.At 1 week and 1 month after surgery,WBC count in group A was higher than that in group B and Group C(P=0.03,P=0.009;P=0.010,P=0.009),there was no significant difference in PLT count between group B and group C(P=0.956;P=0.702);Three months after operation,WBC count in group B was significantly higher than that in group A and C(P=0.001,P < 0.001),and WBC count in group A was significantly higher than that in group C(P < 0.001).6 months and 1year after surgery,WBC count in group B was significantly higher than that in groups A and C(P < 0.001,P=0.003;P < 0.001,P < 0.001),there was no significant difference in WBC count between groups A and C(P > 0.999;P > 0.999).4.Comparison of peripheral red blood cell count at different periods after PSE in the three groups:The RBC count of group A 1 year after surgery was higher than that before surgery(t=-3.369,P=0.002),the RBC count of group B and group C 6 months after surgery and 1 year after surgery was higher than that before surgery(P < 0.05),there was no statistical significance in the RBC count of the remaining postoperative periods compared with that before surgery(P > 0.05).Comparison between groups:There was no significant difference in the overall mean of RBC count at each follow-up time point among groups A,B and C(P > 0.05).5.Comparison of liver function indexes in different periods after PSE in the three groups:The TBIL,AST,ALT,PT and Child-Pugh scores of the three groups were significantly increased and reached the peak value 1 week after surgery,which was significantly higher than the preoperative level(P < 0.05).At 1 year,PT and Child-Pugh scores of the three groups were significantly lower than the preoperative level(P < 0.05).The TBIL of group A and group B was significantly lower than that before surgery(P < 0.05).The ALB of the three groups was significantly decreased at1 week after surgery(P < 0.05),and at 1 year,the ALB of groups A and B was significantly higher than that before surgery(P < 0.05).One week after surgery,TBIL,AST and Child-Pugh scores in group A were significantly higher than those in group B and group C(P < 0.05),but there was no significant difference in TBIL,AST and Child-Pugh scores between group B and group C.Three months after surgery,the Child-Pugh score of group C was significantly higher than that of group A and Group B(P < 0.05),and there was no statistical significance in the difference between group A and group B.5.Spleen volume measurement and imaging changes:There was no significant difference in preoperative spleen volume,residual spleen volume and splenic embolization rate among group A,B and C(F=2.264,P=0.119;F=0.069,P=0.933;F=1.092,P=0.342).The cumulative embolic volume of group C was significantly higher than that of group A and B(P < 0.001,P=0.010),and that of group B was significantly higher than that of group A(P=0.030).The cumulative microsphere usage of group C was significantly higher than that of group A and B(P < 0.001,P=0.022),and the cumulative microsphere usage of group B was significantly higher than that of group A(P=0.011).There was no significant difference in splenic volume per unit mass between the three groups(F=0.247,P=0.782).6.Postoperative adverse reactions and complications:The incidence of postoperative abdominal pain,fever and portal vein thrombosis in group A was significantly higher than that in group B and C,and the difference was statistically significant(P < 0.05).There was no significant difference in the incidence of postoperative abdominal pain and fever between group B and group C,P > 0.05.There were no significant differences in the incidence of postoperative nausea,vomiting and pleural effusion among the three groups(P < 0.05).During follow-up,no serious complications such as spleen abscess and liver failure occurred in all patients.Conclusion(s):1.Fractional PSE at different time intervals and one-time PSE can significantly improve the decrease of peripheral blood image caused by portal hypertension and hypersplenism in cirrhosis;The curative effect of PSE 1 month apart is better than PSE 3 month apart and PSE once;2.Fractional PSE is safe,and the incidence of postoperative abdominal pain,fever and portal vein thrombosis is significantly lower than that of one-time PSE. |
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