The Clinical Efficacy Of Portal Hypertension In Cirrhosis With Partial Splenic Artery Embolization

Cirrhosis is caused by one or many causes, with nodular regeneration and the formation of false lobules for the pathological features of chronic liver disease,which is a common disease in our country.There are a lot of causes of cirrhosis, the viral hepatitis liver cirrhosis are common causes in our country, the incidence of alcoholic liver cirrhosis is also increasing year by year.Compensated cirrhosis is no obvious clinical manifestations, but the decompensated cirrhosis of liver in the clinical perform mainly hypohepatia and portal hypertension. The average survival time of patients with compensated cirrhosisis is 12 years, compared with decompensated cirrhosis 2 years,the main cause for death related with liver function failure and portal hypertension in decompensated cirrhosis. Previously chief treatment for portal hyperten sion is surgical intervention,the classic surgical technique for portal hypertension were portosystemic shunt and devascularization surgery, both satisfact for alleviating hypersplenism, prevention of bleeding and hemostatic effect;But after portosystemic shunt, reduced hepatic blood flow cause liver atrophy and hepatic steatosis, and more patients prone to hepatic encephalopathy;And devascularization surgery also showed shortages in haemostasis, higher rebleeding rate, refractory ascites, aggravating portal hypertension gastropathy.And the surgery also deprivated normal spleen function, which made impaired immune function and increased postoperative deadly infections. Lots of patients could not accept the surgery for liver function failure and expensive surgery charge.Transijugular intrahepatic portal systemic shunt(TIPS)for patients with esophageal varices emergent bleeding is a safe and effective treatment.which presents advantages of small traumatic, significantly decreasing portal pressure.However, the main problems are shunt stenosis and higher occlusion rate, beside, after TIPS,the incidence of hepatic encephalopathy is also high . Since 1979 Spigos,the first man using the partial splenic embolization( PSE) treating hypersplenism,people had gradually found that PSE not only could relieved hypersplenism, but also retained partial splenic organization and its functions, whhich conducived to enhancing the ability of immune and preventing the infection,and also reducing portal pressure and improving liver function.For its good efficacy and few complications, PSE has been widely used in clinic. In this paper, from January 2007 to February 2009 , 23 cases of liver cirrhosis with portal hypertension and hypersplenism were operated with partial splenic artery embolization , we preliminary study the clinical efficacy and safety of PSE to liver cirrhosis by observing peripheral blood cells, liver function albumin and cholinesterase, portal vein hemodynamics, postoperative complications,to provide some reference for clinical treatment of portal hypertension in liver cirrhosis.Objective: To explore the clinical efficacy and application value of the partial splenic arterial embolization (Partial Splenic Arterial Embolization, PSE) in treating portal hypertension in liver cirrhosis.Data and Methods:23 different causes of cirrhosis patients with portal hypertension, Child-push preoperative grade, 12 cases of which are the A-class, while B class 8, C-class 3, 7 had history of gastrointestinal bleeding , 11 with mild to moderate ascites, and 23 have varying degrees of splenomegaly, splenic vein and portal vein widened through different methods of imaging examinations. Purifying the intestinal tract at preoperative by taking antibiotics norfloxacin and metronidazole orally.Using Seldinger technique,4F-5F catheter is entered the celiac artery through the femoral artery,cannulling to splenic artery,then to splenic arteriography, selec- tting the splenic artery, cutting the gelatin sponge into 2mm×2mm×2mm size of particles, adding gentamicin 160,000 units, mixed 15 ~ 20ml contrast agent, using non-selective splenic artery embolization technology, injectting repeatedly and slowly. According to the slower flow velocity and the embolic situation of peripheral splenic artery of splenic paragraph,we can control the degree of embolization. After embolization , tube back to the trunk of splenic artery, doing splenic artery angiography again, if embolic areas are not enough,operarer may add appropriate gelatin sponge particle, striving to achieve a better embolic effect. Based on the patient's liver function ,the embolic area should be controlled at 30 ~ 70%. After PSE, the patients need lying in bed for 24 hours, protectting liver function after operation and application of antibiotics for 4 ~7 days to prevent infection.Preoperative and postoperative 1 week, 1 month, 3 month, 6 months, observing peripheral blood cells, liver function changes in albumin and cholinesterase ,and the portal vein and splenic vein diameter and flow velocity by color Doppler,and calculate the volume of blood flow;recording embolic area and complications respectively.Results:1.Hemogram: After 1 week platelet and WBC increase significantly ,after one month the trend is relatively stable, showing slowly downward trend. Postoperative periods ,white blood cells, platelets compared with the preoperative increased significantly,showing statistical significance;The peripheral red blood cells and hemoglobin do not increase obviously in the forward 3 months after operation,3 months later they begin to increase, compared with the preoperative showing statistical significance.2. Liver function: After 3 months,the albumin and cholinesterase increase significantly, compared with the preoperative showing statistical significance; after 6 months the trend is particularly evident; but after 1 week the cholines- terase reduce in varying degrees, compared with the preoperative,the difference is significant;but the albumin postoperative 1 week reduce does not obviously, compared with preoperative showing non-statistical significance3.hemodynamic changes in portal system: The splenic vein diameter, portal vein and splenic vein blood flow velocity and volume of blood flow, are lower than the preoperative in all postoperative patients, statistical analysis showing statistical significance P <0.05; but compared with preoperative ,the narrow of portal vein diameter dosˊt obviously in 6 months , no statistical significance P≥0.05.4. Postoperative Complications: Varying degrees of left upper abdominal pain, fever for all patients; a very small number of serious complications. There is no statistical significance between embolization areas and heavier embolization complications.Conclusion:PSE can effectivly mitigation cirrhosis hypersplenism ,enhance platelet, white blood cell, red blood cell and hemoglobin, which is conducive to enhancing the immune ability of patients and reducing the risk of bleeding; increase albumin and cholinesteras,improve liver function;reduce portal pressure, mitigate portal hypertension gastropathy ,reduce the risk of esophageal varices bleeding;If mastering indications,PSE is a safe and effective treatment method for treating liver cirrhosis with portal hypertension.