| Objective:Summarize the factors influencing efficacy and adverse reactions of hepatic cirrhosis with hypersplenism treated with partial splenic embolization(PSE).Materials and methods:Review the clinical data of 100 hepatic cirrhosis hypersplenism patients treated with the partial splenic embolization(PSE) from January 1997 to October 2015 in the first affiliated hospital of nanchang university.According to the different embolization methods,locations, materials, ranges and whether used gentamicin + dexamethasone during operation,the data is divided into six groups.Group A:16 patients used gelfoam to block the main of the splenic artery,embolization in the range less than 40%, and used gentamicin + dexamethasone during operation.Group B:15 patients used gelfoam to block the main of the splenic artery,embolization in the range between 40%-70%, and used gentamicin + dexamethasone during operation.Group C: 14 patients used gelfoam to block the main of the splenic artery,embolization in the range greater than 70%, and used gentamicin + dexamethasone during operation. Group D:20 patients used gelfoam to block the lower splenic artery, embolization in the range between 40%-70%, and used gentamicin + dexamethasone during operation.Group E:20 patients used embosphere molecule to block the lower splenic artery,embolization in the range between 40%-70%, and used gentamicin + dexamethasone during operation.Group F:15 patients used gelfoam to block the main of the splenic artery,embolization in the range between 40%-70%, and didn't used gentamicin + dexamethasone during operation.Compare the changes of blood cells count before PSE and after 1 week, 1 month,3 months, 6 months with the different embolization locations, materials, ranges during operation.Compare the changes of liver function before PSE and after 1 week, 2 week,1 month,3 months.Compare the changes of PV inner diameter and SV inner diameter in different embolization ranges before PSE and after 1 week,1 month;and simultaneously observe the reactions and complications after PSE.Results:1.Compare the changes of blood count before PSE and after PSE in different embolization ranges: WBC PLT, RBC count of group A(<40%), group B(40%-70%), group C(>70%) after 1 week, 1 month, 3 months, 6months compared with the preoperative, WBC and PLT count were significantly higher than the preoperative, the differences were statistically significant(P <0.05); but RBC count after 1 week, 1 month had no significant difference(P> 0.05), RBC count after 3 months, 6 months were higher than the preoperative, the differences were statistically significant(P <0.05). Different groups of the same point in time after the WBC, PLT, RBC count by analysis of variance, the differences of WBC, PLT after 1 week, 1 month, 3 months, 6 months were statistically significant(P <0.05); RBC count after one week, 1 month had no significant difference(P> 0.05), differences after 3 months, 6 months were statistically significant(P <0.05); group C(> 70%) the largest blood count increase.2.Compare the changes of PV, SV inner diameter before PSE and after PSE in different embolization ranges: PV, SV inner diameter 0f group A(<40%), group B(40%-70%), group C(>70%) after 1 week and 1 month compared with the preoperative,A group(<40%) after 1 week, 1 month had no significant difference(P> 0.05); group B(40%-70%) after 1 week had no significant difference. Group B(40%-70%) after 1 month PV fell from preoperative 18.1 ± 2.4mm to 14.4 ± 2.6mm, the difference was statistically significant(P <0.05); SV fell from preoperative 13.3 ± 1.3mm to 11.2 ± 1.4mm, the difference was statistically significant(P <0.05).C ?(>70%). Group C(> 70%) after 1 week, after 1 month PV fell from preoperative 18.4 ± 1.9mm to 13.1 ± 1.7mm, the difference was statistically significant(P <0.05); SV fell from preoperative 13.5 ± 1.5mm to 10.1 ± 0.9mm, the difference was statistically significant(P <0.05). the PV inner diameter of different groups after 1 week showed no significant difference(P> 0.05), after 1 month difference was statistically significant(P <0.05); differences of different groups SV inner diameter after 1 week, 1 month were statistically significant(<0.05), group C(> 70%) PV, SV diameter narrowed the most obviously.3.Compare the changes of blood count before PSE and after PSE in different embolization locations: WBC PLT count of group B(trunk), group D(lower pole of the spleen) after 1 week, 1 month, 3 months, 6months compared with the preoperative, WBC and PLT count were significantly higher than the preoperative, the differences were statistically significant(P <0.001); but RBC count after 1 week, 1 month had no significant difference(P> 0.05), RBC count after 3 months, 6 months were higher than the preoperative, the differences were statistically significant(P <0.05).For group B(trunk) and group D(lower pole of the spleen) blood count after the same time period pairwise comparison, the improvement of WBC, PLT in group B(trunk) than that in group D(lower pole of the spleen) significant,the difference was statistically significant(P <0.05); between different groups RBC after 1 week, 1 month had no significant difference(P> 0.05), RBC after 3 months, 6 months in group B(trunk) lifting than those in group D(lower pole of the spleen) obviously, the difference was statistically significant(P <0.05).4.Compare the changes of blood count before PSE and after PSE in different embolism materials: WBC PLT count of group D(gelfoam), group E(microspheres) after 1 week, 1 month, 3 months, 6months compared with the preoperative, WBC and PLT count were significantly higher than the preoperative, the differences were statistically significant(P <0.05); but RBC count after 1 week, 1 month had no significant difference(P> 0.05), RBC count after 3 months, 6 months were higher than the preoperative, the differences were statistically significant(P <0.05).For group D(gelfoam) and group E(microspheres) blood count after the same time period pairwise comparison, the improvement of WBC, PLT in group D(gelfoam) than that in group E(microspheres) significant,the difference was statistically significant(P <0.05); the improvement of RBC had no significant difference(P> 0.05).5.Compare the pain and fever after PSE in different embolization ranges: the proportion with moderate to severe pain in group A(<40%) was 31.2%, the proportion with moderate to severe pain in group B(40%-70%) was 80.0%, the proportion with moderate to severe pain in group C(>70%) was 92.9%, the postoperative pain constitute ratio had significant difference(p<0.05); the duration with moderate to severe pain in group A(<40%) was 4.28 ± 1.21(d), the duration with moderate to severe pain in group B(40%-70%) was 7.17 ± 2.37(d), the duration with moderate to severe pain in group C(>70%)was 15.45 ± 1.57(d), P <0.001, the difference was statistically significant. the proportion with moderate to severe fever in group A(<40%) was 25.0%, the proportion with moderate to severe fever in group B(40%-70%) was 40.0%, the proportion with moderate to severe fever in group C(>70%) was 85.7%, the postoperative fever constitute ratio had significant difference(p<0.05); the duration with moderate to severe fever in group A(<40%) was 5.13 ± 0.78(d), the duration with moderate to severe fever in group B(40%-70%) was 9.37 ± 1.68(d), the duration with moderate to severe fever in group C(>70%) was 13.24 ± 0.89(d), P <0.001, the difference was statistically significant.6.Compare the pain and fever after PSE in different embolization locations: the proportion with moderate to severe pain in group B(trunk) was 80.0%, the proportion with moderate to severe pain in group D(lower pole of the spleen) was 30.0%, the postoperative pain constituent ratio had significant difference(p<0.05); the duration with moderate to severe pain in group B(trunk) was 7.17±2.37(d), the duration with moderate to severe pain in group D(lower pole of the spleen) was 5.36±0.47(d), p<0.05, the difference was statistically significant.The postoperative pain constituent ratio of group B(trunk) and group D(lower pole of the spleen) had no significant difference(p>0.05); the duration with moderate to severe fever in group B(trunk) was 9.37 ± 1.68(d), the duration with moderate to severe fever in group D(lower pole of the spleen) was 4.15±0.32(d), P<0.001, the difference was statistically significant.7.Compare the pain and fever after PSE in different embolization materials: The postoperative pain constituent ratio of group D(gelfoam) and group E(microspheres) had no significant difference(p>0.05); the duration with moderate to severe pain in group D(gelfoam) was 5.36±0.47(d), the duration with moderate to severe pain in group E(microspheres) was 3.13±0.18(d), P<0.001, the difference was statistically significant. the proportion with moderate to severe fever in group D(gelfoam) was 40.0%, the proportion with moderate to severe fever in group E(microspheres) was 10.0%,the postoperative fever constituent ratio of group D(gelfoam) and group E(microspheres) had significant difference(p<0.05); the duration with moderate to severe fever in group D(gelfoam) was 4.15±0.32(d), the duration with moderate to severe fever in group E(microspheres) was 3.09±0.16(d), P<0.001, the difference was statistically significant.8.Compare the pain and fever after PSE whether used gentamicin + dexamethasone during operation: The postoperative pain constituent ratio of group B(used gentamicin + dexamethasone) and group F(not used gentamicin + dexamethasone) had no significant difference(p>0.05); the duration with moderate to severe pain in group F(not used gentamicin + dexamethasone) was 10.29±0.62(d), the duration with moderate to severe pain in group B(used gentamicin + dexamethasone) was 7.17±2.37(d), P<0.001, the difference was statistically significant. the proportion with moderate to severe fever in group F(not used gentamicin + dexamethasone) was 80.0%, the proportion with moderate to severe fever in group B(used gentamicin + dexamethasone) was 40.0%,the postoperative fever constituent ratio of group B(used gentamicin + dexamethasone) and group F(not used gentamicin + dexamethasone) had significant difference(p<0.05)); the duration with moderate to severe fever in group F(not used gentamicin + dexamethasone) was 12.43±1.56(d), the duration with moderate to severe fever in group B(used gentamicin + dexamethasone) was 9.37±1.68(d), P<0.001, the difference was statistically significant.Conclusion:1.The larger the range embolism, blood count improved more significantly, PV, SV reduced more significantly, where embolism range less than 40%, PV and SV hadn't narrowed obviously, but the greater the range embolism, the more severe the degree of the pain and fever and the longer its continued time,so recommend embolism range to be controlled between 40%-70%.2.The clinical efficacy of blocking the main of the splenic artery is superior blocking the lower splenic artery, but postoperative pain and fever lasts longer than blocking the lower splenic artery,under clinical use should be weighed.3.Embosphere microspheres used in the PSE has a good efficacy and safety, is better than gelfoam particles, is worthy of clinical application.4.Intraoperative use of gentamicin and dexamethasone can reduce the degree of fever and reduce the duration of pain and fever. |
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