A Study Of Partial Splenic Embolization (PSE)to Alleviate Hepatic Venous Pressure Gradient(HVPG) In Cirrhotic Portal Hypertension

BackgroundPatients with decompensated cirrhosis is often accompanied by increased resistance and portal vein blood flow increases as a result of portal hypertension, and other coplications, such as esophageal varices appear, splenomegaly, hypersplenism, occur in these patients. With the development of interventional therapy in recent years, a novel method-partial splenic embolization (PSE)-has become an effective treatment measure to portal hypertension caused by cirrhosis. PSE, which not only remit hypersplenism, but decrease the blood flow to spleen simultaneously, can reduce the pressure of port vein effectively.Hepatic venous pressure gradient (HVPG), the differences between hepatic vein and inferior vena cava, behalf of portal vein pressure, was considered as gold standard to evaluate the severity of portal hypertension, which has good predictive value for a series of complications (such as esophageal variceal bleeding) due to portal hypertension.Patients in this study accepted PSE. To determine the embolic area and HVPG differences (Δ HVPG) between before and after operation, we can evaluate the correlation between the embolic area and Δ HVPG. Then we can explore the extent of PSE and prevent the occurrence of esophageal variceal bleeding.Materials and methods17patients in this study all come from Shangdong Provincial Hospital.All patients were during decompensated cirrhosis phase and accepted PSE. We determine the embolic area, ΔHVPG, HVPG pre-PSE,HVPG after PSE.and assess the correlation between embolic area and ΔHVPG. At the same time, observe the complication after the operation, like fever, abdominal pain and death. We also compare the number of RBC, WBC, PLT before and after PSE, and observe the change of ALT, ALT, ALB, TBIL which stand for the liver founction. All data is analysed by SPSS17.0.Statistical. Significance was evaluated using an paired Student t-test in all experiments. A p value<0.05was considered significant.ResultThe effect of PSE to reduce HVPG is significant(P<0.05). And we find the liner relationship between embolic area and ΔHVPG/pre-HVPG, the equation is Y=0.685X-0.180*X. According to the equation, the smallest embolic area is55%to reduce the HVPG by20%.There are9cases kept followe-up and for at least1year,6cases of whose combined with endoscopic variceal ligation(EVL) or percutaneous transhepatic variceal embolization(PTVE). No reblooding case. But there was a case with recurrence of esophageal varices.AS for complications, most cases had fever, bellyache and ascites. Five cases had portal embosism, the incidence is29.4%. No serious complications occurred in patients like splenic abscess. All the patients improved and discharged after conventional treatment, with no deaths.The amount of WBC, PLT after PSE1week,1month,3-6months than before had significantly increased (P<0.05). There were no significant change in glutamic oxalacetic transaminase(AST), glutamic pyruvic transaminase(ALT)、 total bilirubin(TBIL).ConclusionPSE can signifcantly reduce HVPG for patients with portal hypertension. There is a liner relationship between embolic area and ΔHVPG/pre-HVPG. The least embolic area is55%to prevent rebleeding. At the same time PSE can significantly improve the lever of WBC and PLT, so to treat hypersplenism. The main complications are fever, abdominal pain and ascites. All the symptoms can be improved after treatment, without lethal complication. As a result, PSE is a safe treatment.