| BackgroundThe splenic artery steal syndrome(SASS)is a controversial diagnosis.It shows in patients undergoing liver transplantation the thicker splenic artery compete blood flow with the common hepatic artery,in order to “seize” blood flow from the celiac axis.The common hepatic arterial was non-obstructive and hypoperfusion,graft liver and liver ischemia and hypoxia,liver necrosis.The harm caused by the syndrome to liver transplant patients has gradually attracted the attention of clinicians.In clinical work,we have found that after successful treatment of viral replication in some patients with liver cirrhosis and portal hypertension,there is still slow progression of liver cirrhosis and liver function damage.Is SASS common in patients with cirrhosis and portal hypertension? Whether the splenic artery steals blood flow from the hepatic artery,causes hepatic arterial infusion,and hepatic tissue ischemic and hypoxic,resulting in a slow progression of cirrhosis? Reports are relatively few.The clinical significance of steal syndrome in the diagnosis and treatment of patients with hepatitis B liver cirrhosis has not yet received sufficient attention.Objective(1)Multi-phase contrast-enhanced CT scanning of 320-slice in the abdomen was used to measure the main diameter of the common hepatic artery and splenic artery in the experimental group(hepatic portal vein hypertension in hepatitis B patients)and control group(normally healthy individuals).Is there a clinically significant presence in patients with hardened portal hypertension?(2)To observe the effect of partial splenic artery embolization on hepatic arterial infusion and liver function in patients with hepatitis B cirrhosis and portal hypertension with hypersplenism.Whether partial splenic artery embolization can be used to correct hypersplenism while increasing hepatic arterial blood flow.Improve liver function and try to provide a new theoretical basis for the treatment of clinical cirrhosis.MethodsThe first part: Using 320-slice CT multi-phase enhanced examination of the upper abdomen to observe the incidence of SASS in patients with hepatitis B liver cirrhosis and portal hypertension.In other words,the experimental group(hepatitis B cirrhosis with portal hypertension)and control group(normal healthy subjects)underwent multi-phase CT examination of the abdomen with 320-slice.The main diameters of the common hepatic artery and the splenic artery of each subject were measured and the diameter ratio between the spleen artery and the common hepatic artery was calculated.The second part: After the celiac artery angiography in patients with hepatitis B liver cirrhosis and portal hypertension with hypersplenism,partial splenic artery embolization was performed.Short-term follow-up of each experimental subject was performed to evaluate the efficacy: each experimental subject was underwent celiac artery angiography.The main diameters of the common hepatic artery and the splenic artery were measured before operation and the inner diameter ratio between the spleen artery and the common hepatic artery was calculated.Subsequent experimental subjects performed partial splenic artery embolization,and the embolization area was 60%-70%.Immediately after partial splenic artery embolization,the main inner diameters of the common hepatic artery and the splenic artery of each subject were measured,and the splenic hepatic artery and common hepatic artery Inner diameter ratio was calculated.Than short-term follow-up.The follow-up content was the index of laboratory tests(liver function,complete blood count,four blood coagulation function),the common hepatic artery and the splenic artery in one week after the splenic artery embolization,than comparison of the preoperative with the postoperative results for each part,conduct short-term efficacy assessment.Results1.In the first part,the diameter of the main trunk of the common hepatic artery in the experimental group(4.01±0.76mm),which was significantly smaller than that of the control group(4.51±0.42mm)(P=0.002);the diameter of the spleen artery in the experimental group(6.41±1.31mm)was lower than that of the control group(4.61±0.46)mm(P=0.000).The ratio between the splenic artery and common hepatic artery in experimental group was 1.64±0.42,significantly greater than the ratio in the control group 1.02±0.12(P=0.000).2.In the second part,partial splenic artery embolization was observed in each patient with hepatitis B liver cirrhosis and portal hypertension with hypersplenism.(1)Peripheral blood counts: Platelet counts were(60.94±2.62)× 109/L before surgery and significantly increased one week after the surgery.Up to(178.27±16.14)×109/L(P=0.000),and it rose steadily to(198.08±16.67)×109/L(P=0.000)in the first month after the surgery;preoperatively,the peripheral white blood cell count was(2.46±0.16)×109/L,a week after surgery was significantly improved to(7.57±0.53)×109/L(P=0.000),and it slightly decreased to(5.84±0.39)×109/L(P=0.000).(2)The diameters of the common hepatic and splenic artery: the diameter of the common hepatic artery immediately after surgery was 4.66±0.14 mm,significantly wider than the preoperative 3.88±0.11mm(P=0.000),and slightly narrowed to 4.45±0.12 mm after one week.The first month after the surgery,it was 4.34±0.13 mm,but it was still significantly wider than preoperate(P=0.000).The diameter of the splenic artery diameter was 6.88±0.18 mm before operation,and it was not significantly changed immediately after the operation,it was 6.79±0.20mm(P=0.252).In one week after surgery,the splenic artery diameter narrowed to 6.07±0.17mm(P=0.000),and it steadily decreased to 5.48±0.20mm(P=0.000)in the first month after operation.The diameter ratio between the splenic artery and common hepatic artery was 1.51±0.05 immediately after surgery,which was significantly decreased than preoperative 1.88±0.05(P=0.000),the first week after surgery it was 1.42±0.04,and remained slightly decreased to 1.31±0.04(P=0.000)after the first month.(3)Liver function: one week after surgery the alanine aminotransferase was(27.26 ± 2.51)U/L,lower than preoperative(46.04 ± 7.85)U/L(P=0.012),in the first month after operation,it reduce to(27.01±2.81)U/L(P=0.013);?-glutamyl transpeptidase was(49.74±6.16)U/L in one week and(44.98±4.87)U/L in one month after the operation,they were all lower than the preoperative(59.25±8.69)U/L,and the difference was statistically significant(P=0.034)in the first month after operation.(4)The prothrombin time was 10.52±1.09 s in one week after surgery,which was significantly shorter than the preoperative 15.25±0.30s(P=0.000),and was slightly longer in the postoperative month 11.45±1.20s(P=0.002).Conclusions1.Patients with hepatic cirrhosis of portal vein hypertension: The diameter of the common hepatic artery is significantly reduced,and the diameter of the splenic artery is significantly increased.So in patients with hepatitis B cirrhosis and portal hypertension exists the phenomenon of SASS.2.Partial splenic artery embolization can effectively treat hypersplenism.3.In patients with hepatitis B cirrhosis and portal hypertension,partial splenic artery embolization can increase the common hepatic artery blood flow,improve liver blood and oxygen supply,partially correcting SASS,and partially improve liver function in the short term,further confirmed that the clinical value of SASS in portal hypertension of liver cirrhosis. |
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